REPUBLIC OF THE PHILIPPINES )

SAN NICOLAS, ILOCOS NORTE ) S.S

AFFIDAVIT OF LOSS

I, JESSICA T. SALWAGAN, single, of legal age, Filipino citizen, and a resident of 119
Blk2 Middle Quirino Hill, Baguio City, Benguet, Philippines, after having been duly sworn to in
accordance with law hereby depose and states that;

1. I am a holder of a Philippine passport issued by the Department of Foreign Affairs

(DFA), Baguio City branch;

2. Very significantly, sometimes on October 2021, I went to Laguna ta take a vacation.

Relatively, I brought with me said passport and placed it inside a brown envelope;

3. Upon arriving home, however, I noticed that the said passport was no longer inside
the said brown envelope where I last kept it;

4. I immediately exerted diligent efforts to search for the whereabouts of the said
passport. Regrettably, all of my efforts turned futile. Hence, I now consider the said
passport lost and beyond recovery;

5. The said passport was neither confiscated nor seized for any violation of law, rules
and regulation;

6. I am executing this affidavit to request the authorities concerned to issue a new

Philippine passport in lieu of the lost one; and

7. That I am executing this affidavit to attest to the veracity of my statements and for
whatever intents and purposes it may lawfully serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 30th day of September
2022 at San Nicolas, Ilocos Norte, Philippines.

JESSICA T. SALWAGAN
Affiant
ID NO.________________

SUBSCRIBED AND SWORN to before me this 30th day of September 2022 at San
Nicolas, Ilocos Norte, Philippines.

Doc. No.___;
Page No. __;
Book No. __;
Series of 2022.