Republic of the Philippines)

Done: In the City of Baguio) s.s.

AFFIDAVIT OF NON-SUBMISSION OF DOCUMENT

I, PERCIVAL V. POBRE, of legal age, married, Filipino Citizen and a

resident of San Agustin, Isabela, Philippines, after having been duly sworn to
in accordance with law hereby depose and state:

1. That I have been travelling abroad to work for a long time, hence, I am
a holder of a Philippine Passport issued on June 04, 1990;

2. That, however, I could not remember anymore where I kept the said
old Passport. I am not sure if it was destroyed or eaten by termites or
insects or I just thrown away considering the years that lapse;

3. That I did not submit the said passport or surrender it to any

government entity because of physical impossibility for the reason
that I was not here in the Philippines during those time;

4. That I am executing this Affidavit to attest to the truth of the foregoing

facts and for all legal intents and purposes it may serve.

IN WITNESS HEREOF, I have hereunto set my hand this 1 st day of

March, 2019 at Baguio City, Philippines.

PERCIVAL V. POBRE
AFFIANT

SUBSCRIBED AND SWORN to before me this 1st day of March, 2019 at

Baguio City, Philippines. Affiant personally appears and to be the same person
who executed this instrument voluntarily.

MODESTO T. ANDONG
Notary Public
Commission No. 39-NC-18-R/Until: Dec. 31, 2019
PTR No. 3954050/1-3-2019/Baguio City
IBP No. 02793/1-3-2019
Roll No. 31289/5-15-81/Manila
Doc. No. 318; MCLE COMPLIANCE No. VI-0000192/June 14, 2016
Page No. 64; BIR TIN No. 121-017-652
Book No. 34; No. 19, 2nd Floor Old Market Bldg.,
Series of 2019. Magsaysay Ave., Baguio City, Philippines