Republic of the Philippines)

Santa Cruz, Laguna ) s.s.

AFFIDAVIT OF LOSS

I, JOESLITO G. BATUNGBAKAL, of legal age, Filipino, with residence and

postal address at Daangbakal, Pagsawitan, Santa Cruz, Laguna, after having been
sworn in accordance with law, hereby depose and state that -

1. I previously had a Philippine Passport which is now already expired.

2. Unfortunately, sometime in the year 2010 or close to that period of time, the
said passport was lost during a laptop robbery committed by unknown
person/s in my office at 117 P. Guevarra Street, Santa Cruz, Laguna. The
passport was inside the laptop bag which was taken away by the robber/s.

3. Inspite of diligent efforts in trying to locate my passport alongside the

other items which were taken, I can no longer find it. Hence, for all intents
and purposes, the said passport is now deemed lost and beyond recovery.

4. I executed this affidavit to attest to the truth of the foregoing declarations

and to serve as supporting documentary proof in securing a new passport.

IN WITNESS WHEREFORE, I hereto affixed my signature this

___________________ in Santa Cruz, Laguna.

JOSELITO G. BATUNGBAKAL
Affiant

SUBSCRIBED AND SWORN to before me this ________________ at Santa

Cruz, Laguna by the affiant with Driver’s License No. N26-01-099223 issued at
LTO Pila District Office, valid until 12 December 2016.

Doc. No. _____; A T T Y. E M M A N U E L E . S A N D I C H O

Page No._____; NOTARY PUBLIC, COMMISSION UNTIL 31 DEC. 2016
Book No._____; NOTARY PUBLIC FOR THE PROVINCE OF LAGUNA
Series of 2016. PER NOTARIAL COMMISSION SP. PROC. NO. 164(15)
IBP O.R. No. 995689, 04 January 2016, Laguna Chapter
PTR O.R. No. 2967138, 04 January 2016, Laguna
Roll No. 42246, admitted to practice law on 9 May 1997
MCLE Compliance No. V-0015412, dated 6 March 2016