REPUBLIC OF THE PHILIPPINES )

City of Roxas ) S.S.

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

AFFIDAVIT

I, GRACE L. BIGUAL, Filipino, of legal age, single and a resident

of Brgy. Dulangan, Pilar, Capiz, after having been duly sworn in
accordance with law, hereby depose and state:

1. That I am a Philippine citizen and holder of Philippine

passport with Passport No. EC2388167, issued on 13
October 2014, with expiry date on 12 October 2019 and
issued at Iloilo City;

2. That on November 25, 2019 at 6:00 am, while I was

travelling to Iloilo City to renew my passport, I noticed that
said passport placed in my bag was missing. I could no
longer find it in my bag and in my other belongings. The
same could not also be found in my house. A Police Blotter
Report stating the circumstances of how I lost my passport
is hereto attached;

3. That efforts were exerted to locate the lost passport, but

in spite of diligent search, it could not be found and the
same is now beyond recovery;

4. That I need my passport urgently because I am planning

to work abroad;

5. That in view of the foregoing explanation, it is requested

that a new passport be issued to the undersigned, in lieu of
the lost passport, subject to compliance with prescribed
requirements;

6. That I attest to the veracity of the above affirmation.

IN WITNESS WHEREOF, I have hereunto set my hand this

27 day of November, 2019 at the Roxas City, Philippines.
th

GRACE L. BIGUAL
VIN: 1914-0134B-
F0389GLB20000

SUBSCRIBED AND SWORN to before me this 27th day of

November 2019, in the City of Roxas, Philippines. I further
CERTIFY that I have personally examined the affiant, and I am
fully satisfied that he voluntarily executed the foregoing Affidavit,
and he read and understood the contents thereof.