REPUBLIC OF THE PHILIPPINES

DONE IN THE CITY OF BAGUIO) S.S.

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AFFIDAVIT OF LOSS OF PHILIPPINE PASSPORT

I, JOHN QUINTO VELASCO, of legal age, a dual Filipino and American citizen,
married and a resident of No. 40 P. Burgos, Baguio City, Philippines, after being duly
sworn in accordance with law, depose and state:

1. That I am a a bona fide holder of a Philippine Passport with its particulars I can
no longer recall;

2. That on May 3, 1983, I used my Philippine Passport when I travelled to the

U.S.A.;

3. That I placed the said Passport inside the drawer of my cabinet in Los Angeles,
U.S.A. for safekeeping;

4. That ever since then, I did not bother to check on the said Passport since it was
safe inside my cabinet;

5. That sometime on December 2021, I checked my Philippine Passport before

returning in the Philippines but it could no longer be found;

6. That I checked all the places where I usually put my important documents but I
could not find my Philippine Passport;

7. That the Passport might have been misplaced when I kept moving houses;

8. That in light of the foregoing and despite diligent search and efforts to recover
said Philippine Passport, I could not find the same such that I now declare that
the same is now LOST BEYOND RECOVERY;

9. That I apologize to the Department of Foreign Affairs for my negligence

and I undertake to take care of the passport that will subsequently be
issued under my name;

10. As such, I am executing this Affidavit of Loss to attest to the truth of the
foregoing statements and in to Request the Department of Foreign Affairs to
cause the replacement of the same.

IN WITNESS WHEREOF, I have hereunto set my hand this 8th of January 2022 at
Baguio City, Philippines.

JOHN QUINTO VELASCO

Affiant

SUBSCRIBED and SWORN to before me this 8th of January 2022, in the City of
Baguio, by the Affiant whom I have identified through competent evidence of identity
using his Driver’s License with its bearing numbers A01-21-204957.

Doc No. 683;

Page No. 138;
Book No. XXI;
Series of 2022.