REPUBLIC OF THE PHILIPPINES )

QUEZON CITY ) S.S.

AFFIDAVIT OF LOSS

I, JOSEPH L. HENDRIX JR. , of legal age, Filipino citizen, with residence

address at 38 Woodside Street, Greenview Village, Sauyo road, Fairview
Quezon City, after having been duly sworn to in accordance with law, hereby
depose and state;

1. That I am the holder of PHILIPPINE PASSPORT issued by Department

of Foreign Affairs.

2. That unfortunately the above-mentioned item was lost sometimes on

Year of 1985 when it was accidently fell somewhere;

3. That I exerted diligent efforts to locate and look for the above-
mentioned item in other places, but the same proved futile and to no
avail;

4. That for all intents and purposes, I am now declaring the above-
mentioned item lost and beyond recovery;

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

facts based on my personal knowledge and for whatever legal purpose
it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 20 th day of

February 2024 at Quezon City, Philippines.

JOSEPH L. HENDRIX JR.

Affiant

SUBSCRIBED AND SWORN to before me this 20th day of February 2024 at

Quezon City, Philippines. Affiant exhibited to me his CTC/ID No.
_______________issued on ____________________ at ________________________.

Doc. No.: _____________ NOTARY PUBLIC

Page No.: _____________
Book No.: _____________
Series of 2024