Republic of the Philippines )

Ramon, Isabela )
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AFFIDAVIT OF LOSS

I, ROSELITA ACOB CEREZO, of legal age, Filipino, married and a

resident of Brgy. Bantug, Ramon, Isabela, under oath, hereby depose and
state THAT:

1. I have been issued by the Department of Foreign Affairs (DFA),

NCR West a Philippine Passport with ID No. P5985239A

2. Sometime in 2018, I applied for work abroad and submitted my

passport as requirement of a placement agency in Metro Manila. In
the course of my application, the agency closed its operation and so
the documents I submitted to it, including my passport, were no
longer retrieved. I exerted diligent efforts to secure the said
passport, but in vain, hence, it is now considered lost and beyond
recovery;

3. The loss of my passport is not attributed to my negligence, but it is

solely predicated on circumstances beyond my control;

4. I am executing this Affidavit purposely to inform the Department of

Foreign Affairs (DFA) about the unavailability of my passport on the
basis of the foregoing explanations.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

11th day of February 2024 in Ramon, Isabela.

ROSELITA A. CEREZO
Affiant

SUBSCRIBED AND SWORN to before me this 11th day of February,

2024 at Ramon, Isabela. Affiant has exhibited to me her identification card
bearing her picture and signature as competent proof of her identity.

Doc No.____;
Page No. __;
Book No. __;
Series of 2024.