Professional Documents
Culture Documents
Affidavit of Loss Passport ID
Affidavit of Loss Passport ID
AFFIDAVIT OF LOSS
2. That sometime at about 9:00 am., July 14, 2018 while I was aboard on a
passenger motorcycle travelling from my residence at Sangkol, Dipolog City
going to the City proper in order to withdraw money and upon arrival thereat
I thoroughly search my passport but to my dismay I was not able to retrieved
it despite deligent efforts and I honestly believe it could have fallen either in
the motorcab or somewhere;
3. That I decided to report the incident to the PNP station, Dipolog City to
validate my claim, Photocopy of PNP Incident Report is hereto attached and
marked as Annex “A”;
4. That I am executing this affidavit for the purpose of requesting the DFA,
Zamboanga City, to issue another passport in my behalf in lieu of the lost
one.
GEMMA E. SALMORIN
Affiant
Doc. No.___
Page No.___
Book No.___
Series of 2018.
Republic of the Philippines )
City of Dipolog ) S.S
x------------------------------------x
AFFIDAVIT OF LOSS
2. That the said document while in my possession was misplaced and could no
longer ne located inspite of exerting efforts of locating them;
3. That I am executing this affidavit to attest the truth of the foregoing and for
whatever legal purpose it may serve.
FREDERICK S. CALOG
Affiant
Philhealth ID 16-050166521-2
SUBSCRIBE AND SWORN TO before me this August 31, 2018 at Dipolog City.
Doc. No.___
Page No.___
Book No.___
Series of 2018.