Republic of the Philippines )

Province of Zamboanga del Sur

City of Pagadian          ) S.S.
x--------------------------x

AFFIDAVIT OF DESTRUCTION/MUTILATION OF PASSPORT

I, _____________________, of legal age, single, Filipino citizen, and

presently residing at
__________________________________________________________ Pagadiasn
City, Zamboanga del Sur, 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. ____________ issued

on _________________ by the Department of Foreign Affairs in Cagayan de Oro
City;

2. That the said passport was damaged/mutilated because I

unintentionally dropped it in the toilet due to excitement;

3. That when I picked it up and tried to dry it, it already became

unreadable;

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

travel purposes and therefore I request the Department of Foreign Affairs –
Cagayan de Oro to issue a replacement passport in my favor; and,

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

IN WITNESS WHEREOF, I have hereunto set my hand this 24 th day of

February 2020 at Pagadian City, Philippines.

ACE NORMAN P. ALVERO

Affiant
                                

SUBSCRIBED AND SWORN to before me this 24th day of February

2020 in Pagadian City, Philippines, affiant exhibiting to me his/her School ID
No. 16101158 and his Community Tax Certificate No. 63789254 issued on March
1, 2017 at Burauen, Leyte.

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