REPUBLIC OF THE PHILIPPINES

IN THE CITY OF GINGOOG) S.S

AFFIDAVIT OF DECLARATION

I, ROMEO PETERE PALLUGNA, of legal age, Filipino, married

and with residence and postal address at Purok 1, Barangay Agay-
Ayan, Gingoog City, Misamis Oriental, Philippines, after having
been duly sworn to an oath in accordance with law do hereby
depose and state:

1. That I have a scheduled appointment on December 5, 2022

with the Department of Foreign Affairs in Butuan City for
the processing of my passport;
2. That as part of the requirements for the processing of my
passport, two (2) valid government-issued identification
cards are necessary;
3. That I am presenting my Voter’s ID and my Unified Multi-
purpose ID to DFA-Butuan City for the processing of my
passport;
4. That I am executing this affidavit to declare that the
signatures appearing on my Voter’s ID and my Unified
Multi-purpose ID are my signatures;
5. That I am executing this Affidavit to attest to the veracity
and truthfulness of the foregoing facts.

IN WITNESS THEREOF, I affix my hand this 17th day of

November 2022 in the City of Gingoog, Misamis Oriental,
Philippines.

ROMEO PETERE PALLUGNA

CRN - 0111 - 9278259 - 0

SUBSCRIBED AND SWORN to on the date and place above

written.