Republic of the Philippines)

City of Cebu ) S.S

AFFIDAVIT OF MUTILATION

I, ROUELLA BAUTISTA OCHEA, Filipino citizen, single, and a

resident of Suba, Basbas, Masulog, Lapu-Lapu City, Cebu, after having been
duly sworn in accordance with law, hereby depose and states:

1. That I was issued with a Passport by the Department of Foreign

Affairs on January 22, 2016;

2. That the said Passport was keep inside our wallet;

3. That significant portion of my passport was eaten by termites

causing to its mutilation;

4. That the said mutilation is unintended but due solely on the

foregoing reason;

5. As such, I am executing this Affidavit of Mutilation to attest to the

truth of the foregoing, to support my application for the issuance
of a new passport and for any legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

____________________________ at Cebu City, Philippines.

ROUELLA BAUTISTA OCHEA

Affiant

SUBSCRIBED AND SWORN TO before me this

_____________________ at Cebu City, Philippines, affiant exhibiting to me
his UMID CRN 0111-4785274-1 issued by SSS-Cebu City, as competent
evidence of her identity.

Doc. No. 514 ;

Page No. 103 ;
Book No. I ;
Series of 2019 .