REPUBLIC OF THE PHILIPPINES)

)S.S.

AFFIDAVIT OF LOSS
I, ______________________, of legal age, Filipino, and with residence
address at J___________________________ Quezon City, after having been
sworn in accordance with law, do hereby depose and say THAT:

1. I possess a Philippine Passport which I secured from the

Department of Foreign Affairs;

2. I always place the said passport in a certain plastic envelope

inside our cabinet together with the other equally important
documents I own;

3. I looked for the said passport last December 2018 to prepare it

for my plan to apply for work abroad but unfortunately failed to
locate it;

4. I also looked for the said plastic envelope that contained my

passport in every corner of the house but after all diligent efforts
exerted to locate it, it was nowhere to be found;

5. Earnest efforts were exerted to locate the whereabouts of my

passport but still it cannot be found, hence I declare it as a loss
already;

6. I am executing this affidavit to attest to the truth of the foregoing

and for the purpose of requesting for a new passport from the
Department of Foreign Affairs, Philippines for purposes of travel
abroad in the near future.

IN WITNESS WHEREOF, I have hereunto set my hand this

____________________ day at _______________, Philippines.

_________________________
Affiant

SUBSCRIBED AND SWORN TO before me, in the ______________, this _______

day of __________________ at __________________________, by affiant exhibiting to me his
identification Card with corresponding number ____________________________.

Doc. No. _______;

Page No. _______;
Book No. ______;
Series of ______.