Republic of the Philippines )

City of Cagayan de Oro ) S.S.

AFFIDAVIT OF LOSS

I, NENERICK E. EMNACE, 31 years old, single and a resident of Adelfa

Extension , Zone 9 Carmen, Cagayan de Oro City , after having been sworn to
an oath in accordance with law, do hereby depose and say:

1. That I am the lawful holder of my Philippine Passport duly issued by

DFA;

2. That on October 28, 2017 at 8:00 in the evening, my Philippine Passport

fell from my possession while I was in Cogon Market, Barangay 33,
Cagayan de Oro City;

3. That despite diligent and earnest efforts to locate said Philippine

Passport the same proved futile;

4. That the above-mentioned Philippine Passport is now lost and beyond

recovery;

5. That the said Philippine Passport has not encumbered, sold, pledged,
assigned, alienated, transferred, donated, given as collateral for any debt
or obligation to or in favor of any person or entity;

6. That I understand that my declaration of the abovementioned Passport

as lost shall be construed as satisfactory proof that the Passport was
lost, in compliance with Section 15 of RA 8239 or the Philippine Passport
act of 1996;

7. That I further understand that said Philippine Passport will be

immediately deemed cancelled and may no longer be used for travel or
other purposes. As such, in case the said Philippine Passport is found or
retrieve, undersigned will immediately surrender it to the DFA;

8. That I am executing this affidavit to attest to the truth of the foregoing, to

request the DFA, Cagayan de Oro City for the reissuance of a new
Passport, and for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 16 th day of

October, 2019, in Cagayan de Oro City, Philippines.

NENERICK E. EMNACE
Affiant

SUBSCRIBED AND SWORN to before me this 16th day of October, 2019, in

Cagayan de Oro City, Philippines.