Republic of the Philippines )

City of Zamboanga . . . . . . . )s.s.

x. . . . . . . . . . . . . . . . x)

AFFIDAVIT OF MUTILATION

I, JERRY CANARE GARCIA, of legal age,married, Filipino and a

resident of 421 Capitangan, Abucay, Bataan, depose and state that:

I am the holder of Philippine passport bearing number

EC0907484 issued in PE KUWAIT on APRIL 23, 2014 and will
expire on APRIL 22, 2019;

That on 13 December 2016, when my wife did the laundry

she did not noticed the passport inside my jacket, when she
loaded all the clothes inside the washing machine, it was
only found out later after drying all the clothes from the
laundry area, that my passport was wet and dried up that
cause it to be deform and blurry, I could no longer use the
same for my travel abroad;

I hereby affirm the said mutilation was caused by the

foregoing circumstance;

In view of the mutilation there is a need to apply for

its replacement for purposes of travel abroad;

The said passport has not been encumbered, sold, pledged,

assigned, alienated, transferred, donated, or given as
collateral for any debt or obligation to or in favor of any
person or entity;

I understand that my declaration of the aforesaid

passport as mutilated/ 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;

I further understand that said passport will be

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

I am executing this affidavit to attest to the veracity of

the foregoing facts in support for its replacement and for
all legal intents and purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 20th

day of March 2017 in the City of Zamboanga, Philippines.

JERRY CANARE GARCIA

 Affiant
LICENSE ID NO.CO2-05-002131

SUBSCRIBED AND SWORN to before me this 20th day of March 2017 in the
City of Zamboanga, Philippines.

Doc No.____;
Page No.____;
Book No.____;
Series of 2017.