REPUBLIC OF THE PHILIPPINES)

Baguio City……………………) S.S.

A F F I D A V I T OF LOSS

I, MARILYN GULAYAN SINGAYAN, of legal age, Filipino Citizen, with residence

address at Anonat 2625 Paracelis Mountain Province, after having been duly sworn to in
accordance with law, do hereby depose and state that:

I am a lawful owner and holder of a Philippine Passport with No. P3752942B with an
expiry date on 05 November 2029;

A Midst the pandemic March 2022, I travelled here in Baguio City to look for a better job
to support my family. I took all my valid identification cards including my valid Philippine
passport;

I stayed with my cousin’s boarding house at Brgy. Padre Zamora, Baguio City. During
my stay in my cousin’s boarding house, all of my valid Identification cards and equally
important documents including my passport were kept in a drawer;

On December, I noticed my passport was missing inside the drawer. I did not look for my
passport diligently including not reporting the loss of my passport to the police station since I
know even if it is not inside the drawer it can be found inside the boarding house. It was only the
time when I badly needed my passport that I exerted diligent effort to locate it.

I exerted diligent efforts to locate the said passport by looking into places where it might
have been thrown away, or misplaced, including traveling back to Paracelis Mt. Province to
locate it and inquiring as to whoever might have taken it, but, unfortunately, all my efforts were
in vain. I strongly believe that the said passport was forever lost and beyond recovery;

That the passport was not given to any entity for the satisfaction of any debt nor
confiscated by any law enforcement authority for violation of any law. Neither is the same
cancelled, revoked or withdrawn for violation of any laws, rules and regulations;

If the Department of Foreign Affairs, after inquiry, will find me responsible for the
unauthorized use of the herein reported loss of my above-enumerated passport, I do hereby
signify my conformity to meted administrative fines and penalties due and imposed thereon,
with waiver and desistance on my part for any legal claim or action by reason of the
aforementioned punitive measures taken against me; and

I am executing to attest to the truthfulness of all the foregoing and for all legal intents and
purposes it may serve particularly to request for the issuance of new Philippine passport in lieu
of the lost one.

IN WITNESS WHEREOF, I have hereunto set my hand this 13th day of July 2022 at
Baguio City, Philippines.

MARILYN GULAYAN SINGAYAN

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this 13th day of July 2022 at Baguio
City, Philippines. Affiant personally appeared before me presenting to her Postal ID bearing a
number PRN53190446789 P with her name an signature.

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