Republic of the Philippines )

Province of ____________________) S.S.
City/Municipality of _____________)
x-------------x

AFFIDAVIT OF LOSS

I, _______________, of legal age, Filipino, married, and a

resident of_______________________________, after having been duly
sworn in accordance with law, hereby depose and state:

That on May 21, 2018, I was issued a Philippine Passport by the

Department of Foreign Affairs in Tuguegarao, Philippines;

That sometime in_______________________, I went to a bus

terminal to pick up a package and I was asked to present my
Identification Card to claim the said package;
That since my passport was with me at that time, I presented my
passport and was able to get the parcel;
That when I got home, I checked my passport in my pocket but the
same could not be found;
That I went back to the bus terminal to ask if I left my passport
there but to no avail;
That 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;
As such, 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 of the one which was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this

_____________ at _____________, Philippines.

Affiant
 SUBCRIBED AND SWORN TO before me this ___________
2020 in________________, Philippines, affiant exhibiting to me his valid proof of
identification as indicated below his name.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2020.