Republic of the Philippines

National Police Commission

PHILIPPINE NATIONAL POLICE, NATIONAL CAPITAL REGION POLICE OFFICE
SOUTHERN POLICE DISTRICT
PATEROS MUNICIPAL POLICE STATION
Investigation and Detective Management Section
E. Ragas St., Brgy. Sta. Ana, Pateros, MM
Tel No. 423-2598

CERTIFICATION
This is to certify that quoted hereunder is an Excerpt from the DAILY INCIDENT
REPORT (Police Blotter) as follows:

ENTRY No …………… 2022-389

PAGE NO…………….. 659
DATE…………………. 4/11/2022
TIME………………….. 11:00 AM

RE: ALLEGED LOSS PASSPORT

REPORTEE: ROWENA CRUZ ‘Y ORDIGO, 56 years old, female, widow, Barangay Health
Worker, born on August 16, 2022 in Pateros and a resident of No. 52 E. Hermosa St.,
Barangay San Roque, Pateros, Metro Manila.

DTPO: Discovered sometimes on October 2021 inside her residence located at No. 52 E.
Hermosa St., Barangay San Roque, Pateros, Metro Manila.

ITEM LOST: One (1) Philippine Passport with Passport No. LL125346 issued by
Department of Foreign Affair, Manila.

BRIEF FACTS:

Reportee personally appeared before this office and requested to put into official
record the above captioned incident. Accordingly, she keep the said passport in her bag,
however sometimes on October 2021, she discovered that her bag containing the aforesaid
passport was missing or accidentally disposed of kept somewhere which she could no
longer locate. She exerted diligent effort to locate said passport but to no avail, hence, the
said passport is now considered lost, destroyed and beyond recovery.

THIS CERTIFICATION is being issued upon the request of Rowena O. Cruz for
whatever legal purposes it may serve her best.

PCMS Ricky T Ramos

Duty Investigator