Republic of the Philippines )

City of Cagayan De Oro ) S.S.

x--------------------------x

AFFIDAVIT OF MUTILATION OF PASSPORT

I,INEZ ALEXANDRA P. ALVAREZ , of legal age, single,

Filipina citizen, and presently residing at B37-L36 Frontiera, Gran
Europa, Lumbia, Cagayan De Oro City, with after having been duly
sworn to in accordance with law, do hereby depose and say:

1. That I am a holder of Philippine Passport No. EB9771005

issued on December 07, 2013 ,with expiration date of December 06,
2018 ,by the Department of Foreign Affairs in Cagayan De Oro City;

2. That the said passport was damaged/mutilated on the eve

of July 17, 2018, while I was heading home and due to the heavy rain,
I was forced to hasten my way to the vehicle and accidentally
dropped my bag along with my other things including my passport
that unfortunately got drenched in the murky water. ;

3. That when I picked it up and tried to dry it, some texts are
already blurred and unreadable.;

4. That the damage on the said passport has rendered it

unusable for travel purposes and therefore I request the Philippine
Embassy/ Consulate to issue a replacement passport in my favor ,
and I am making this affidavit also for renewal purposes.;

5. That I attest to the veracity of the foregoing information.

IN WITNESS WHEREOF, I have hereunto set my hand this

14 day of October 2019 at Cagayan De Oro City, Philippines.
th

INEZ ALEXANDRA P. ALVAREZ

Affiant

SUBSCRIBED AND SWORN to before me this 14th day of

October 2019 in Cagayan De Oro City, Philippines, affiant exhibiting
to me her PhilHealth ID No. 15-050409200-5.
 M
OHAMMAD HUSSIEN B. LUCMAN
Oro Legis Law Office
2F Gonzalo Chavez Bldg.
Capistrano corner Tirso Neri
Streets.
Cagayan De Oro City
Serial No. 2019-158
MCLE Exempt
PTR No. 4304484; CDO City
IBP No. 088276; Misamis
Oriental
Roll of Attorneys No. 72305

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Series of 2019