(REPUBLIC OF THE PHILIPPINES

CITY OF MANILA) S.S.

AFFIDAVIT OF LOSS
Re: Passport

I, JEAN PAULA E. ROYO, Filipino, of legal age and with residence address at
1901K. Interior 61 Zamora St. Pandacan Manila after having been duly sworn in
accordance with law, do hereby depose and state:

1. That I am the owner / holder of Philippine Passport Issued to me in year 2015

by DFA;

2. That the said above mentioned Philippine Passport was lost in year 2016 while
on board taxi at 10:00 am from Sta. Cruz Manila going to NAIA Paranaque City.

3. That I exerted diligent efforts to locate my Passport but my effort proves futile
hence my passport may now be be deemed lost and irretrievable;

4. That the said passport has not been encumbered, sold, pledge, assigned,
alienated, transferred, donated or given as a collateral for debt or obligation to or
in favor of any person or entity.

5. That I understand that my declaration of above mentioned passport as lost shall

be constructed as satisfactory proof that the passport was lost in compliance
with section 15 R.A.8239 of the Philippine Passport Act. 1996;

6. That I further understand that the said passport will be immediately deemed
cancelled and may no longer be used for travel or other purpose, as such in
case the said passport is found and retrieved, undersigned will immediately
surrender it to the Department of Foreign Affairs.

7. That I am executing this affidavit for all legal intent and purposes it may serve.

1st
IN WITNESS WHEREOF, I have hereunto set my hand this day of September 2023,
in the City of Manila.

JEAN PAULA E. ROYO

Affiant

SUBSCRIBE AND SWORN to before me at the City of Manila on this 1st day of
September 2023. Affiant exhibited his VOTER's ID No. 3912-3422C-F3090JER20000.