AFFIDAVIT OF LOSS OF PASSPORT AND U.S.

VISA

I, Kyle Cherrie C. Matoza, Filipino citizen, of legal age, single, and presently
residing at B21 L32 Pink St., Camella North Springville. Molino 3, Bacoor City,
Cavite, Philippines, 4102 after having been duly sworn to in accordance with law,
hereby depose and state:

1. That the undersigned was issued a Philippine Passport by the Department of

Foreign Affairs (DFA) in Manila with the following details: Philippine
Passport No: P6731965A, Date of Issue: April 11 2018; and Issuing
Authority: DFA Manila.
2. That the said passport was lost on around June 2022 under the following
circumstances:
 That we had a family trip to Boracay last June 2022;
 That the whole family brought their Philippine passports as proof of
valid identification; and
 That upon returning to Manila, the envelope where the passports were
in for safekeeping was no longer to be found.
3. That the undersigned exerted all efforts possible to locate the said passport
but to no avail;
4. That along with Philippine Passport was a U.S. Visa with the following
details: VISA No: 20192885000002, Visa Type/Class: B1/B2, Date of Issue:
October 18, 2019, and Expiration Date: October 14, 2029.
5. That the undersigned fully understands that the said passport is
automatically deemed cancelled upon declaration of loss and that if found, it
can no longer be used; and
6. That the undersigned is executing this Affidavit of Loss in connection with
her present application for a new Philippine passport as well as the issuance
of U.S. Visa.

NO FURTHER SAYETH.

IN WITNESS WHEREOF, I have hereunto set my hand this

________________ in _______________, Philippines.

KYLE CHERRIE C. MATOZA

SUBSCRIBED AND SWORN to before me, this __________ by affiant

who exhibited to me his Driver’s License No. __________ valid until __________.
Doc. No. _____; NOTARY PUBLIC
Page No. _____;
Book No. _____;
Series of 2023.