Republic of the Philippines )

City of _______________) S.S

AFFIDAVIT OF LOSS
OF PASSPORT

I, Venice Loudette E. Cabigao, of legal age, Filipino, single, and a resident

of # Block 14 Lot 12 Mahogany Street Kingsville Hills Barangay San Jose, Antipolo
City, Rizal, after having been duly sworn to in accordance with law, hereby depose
and state THAT:

1) On August 2, 2016, I was issued a Philippine Passport by the

Department of Foreign Affairs with Philippine Passport No.
EC8467741;

2) Sometime around September 2, 2019, I noted that the said passport

was missing;

3) To my knowledge my passport was lost when my bag was lost;

4) I took great pains to look for the said passport but to no avail;

5) Despite diligent search and efforts to locate the said passport I could
not find the same such that I now believe that it is now lost beyond
recovery;

6) I am executing this Affidavit of Loss to attest to the truth of the

foregoing and to support the application for the issuance of new one
in lieu if the one which was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this September 9,

2019 at San Juan Manila, Philippines.

Venice Loudette E. Cabigao

Affiant

SUBSCRIBED AND SWORN TO before me this 9th of September 2019

in________________________________________, Philippines, affiant exhibiting
to me her student ID as valid proof of identification.

Doc. No. __________;

Page No.__________;
Book No.__________;
Series of 2019.