Republic of the Philippines )

Province of Isabela ) S.c.

City of Ilagan )
x- - - - - - - - - - - - - - - - x

AFFIDAVIT OF LOSS
I, NORMA TURARAY AGCAOILI, of legal age, Filipino, married,
and a resident of Purok 6, Villador, Reina Mercedes, Isabela, under oath depose and
state:

1. That I am the same person executing this Affidavit;

2. That on 28 October 2020, the PE AMMAN issued a Passport to me

with Passport Number P5691185B which is valid until 27 October 2030;

3. That I kept the said Passport in my pouch with other important

documents;

4. That recently, I have decided to process my employment application

abroad. On my way home, I rode a motorcycle and placed my pouch in the back
pocket of my pants. Unfortunately, I noticed that my pouch is no longer in my back
pocket together with my Passport, money and other identification cards;

5. That I exerted diligent efforts to locate the said Passport but all
efforts remained to be futile and in vain, such that I now believe that the same is lost
beyond recovery;

7. That this Affidavit is also executed for the purpose of requesting the
issuance of a new Passport in lieu of the lost one; and

8. That I am executing this Affidavit to attest to the veracity and

truthfulness of the foregoing facts.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

12 day of September 2023 at the City of Ilagan, Isabela.
th

NORMA TURARAY AGCAOILI

Affiant

SUBSCRIBE AND SWORN to before me this 12th day of September

2023 , at the City of Ilagan, Province of Isabela. The identity of the affiant is
established by her Philippine ID No. 6415-3946-3813-5014

ATTY. MARY GRACE M. CAMMAYO-GAOIRAN

Public Attorney II
Administering Oath
Pursuant to R.A. 9406

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