Republic of the Philippines }

City Of Davao }
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AFFIDAVIT

I, _____________UVY LOPEZ PATUNGAN, of legal age, Filipino, single and a resident of

Poblacion, Kiamba, Sarangani Province, hereby depose and say, THAT:

1. Sometime on August 20, 2007, in the afternoon, while I was in Dubai, I commuted by a bus to
proceed to Carreefour Mall;

2. I was bringing along with me my Philippine Passport with number _______ issued on August 06,
2003, which expires on August 06,2008;

3. Upon reaching the office of Carreefour Mall, I alighted from the said bus;

4. When I arrived at the Carreefour Mall, I realized that my old Philippine Passport with number
________ was already missing;

5. That upon examination, I recalled that I left the same in the bus which I boarded on my way to
Carreefour Mall;

6. I tried to look for the said bus, but such effort served to be futile;

7. I could no longer locate and retrieve my Philippine Passport;

8. I am executing this instrument to attest the truthfulness and correctness of the above stated facts
to the best of my personal knowledge;

IN WITNESS WHEREOF, I have hereunto set my hand this 9th day of January 2008 at Davao
City, Philippines.

_____________________
Affiant

SUBSCRIBED AND SWORN to before me this 9th day of January 2008 at Davao City,
Philippines. Affiant exhibited to me her Postal Identification Card with number ___________ which
expires in 01-04-2013.