AFFIDAVIT OF LOSS

I, June R. Caisip , Filipino citizen, of legal

age and presently residing at Manila River City Residences, Sta. Ana Manila
after having been duly sworn to in accordance
with law, hereby depose and state:

1. That I am holder of Philippine Passport No. P5743029A issued on Jan. 24, 2018

2. That sometime around Jan. 4, 2024 , I noted that the said passport was missing.
(date)

3. That to my knowledge, my passport was lost when I travelling back from Ilocos to Manila
(circumstances or event when passport was lost)
I may have lost it before I got into the bus going to Manila.

4. That I took great pains to look for the said passport but to no avail.

5. That I had reported the loss of the said passport to the police authority of

IN TRUTH WHEREOF, I have hereunto signed my name below this day of

at the Embassy of the Philippines in Washington DC.

Affiant
Full Name and Signature