REPUBLIC OF THE PHILIPPINES)

Mandaue City )S.S.

AFFIDAVIT OF LOSS

I, LYNN TORREON GUCELA, of legal age, married, Filipino and a

resident of Ermita Proper, Brgy. Ermita, Cebu City, after having been
sworn to in accordance with law, hereby depose and say that:

1. That I am a bonafide holder of a passport bearing the

numbers XX2272206 issued by the Department of Foreign Affairs;

2. That sometime in March 2014, I misplaced the said passport;

3. That the said passport could not be found despite diligent

efforts to locate the same;

4. That I am executing this affidavit for the purpose of the

renewal of my passport with the Department of Foreign Affairs and to
attest to the veracity and truthfulness of the foregoing facts;

4. Affiant further sayeth naught.

Signed this 1st day of August, 2018 at Mandaue City, Philippines.

CAROLINE AGNES NAJARRO

Affiant

SUBSCRIBED AND SWORN to before me this 1 st day of August

2018 in Mandaue City, affiant exhibiting to me her Driver’s License
bearing the numbers G06-18-009092 as competent evidence of her
identity.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2018.