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Affidavit-Of-Loss Passport 1 - 1
Affidavit-Of-Loss Passport 1 - 1
Batangas )s.s.
X X
AFFIDAVIT OF LOSS
1. I am the owner of a Passport with the number P3739564A issued by the Department of
Foreign Affairs;
2. Sometime around 5:30 in the afternoon on April 15, 2024, in Santiago, Malvar, Batangas
I lost the above Passport under the following circumstances:
3. despite diligent efforts exerted, I could not expect that the said passport was an-
intentionally lost in my bag and I’ don’t expect that it will lost, and to the best of my
knowledge, the same is truly lost;
4. The said Passport has not been confiscated by any officer of the law or the issuing
agency or office due to the violation of any law, statute, order, rule, or regulation;
6. I am executing this affidavit to attest to the truth of the foregoing and to request the
issuance of a new passport to replace the one that was lost.
IN WITNESS WHEREOF, I have hereunto set my hand this 26th of April, 2024, in Malvar,
Batangas, Philippines.
SUBSCRIBED AND SWORN to before me on this 26th day of April 2024, in Malvar,
Batangas Philippines.
Doc. No. ;
Page No. ;
Book No.
; Series of 2024.