Republic of the Philippines

NATIONAL POLICE COMMISSION

PHILIPPINE NATIONAL POLICE, POLICE REGIONAL OFFICE CORDILLERA
MOUNTAIN PROVINCE POLICE PROVINCIAL OFFICE
PARACELIS MUNICIPAL POLICE STATION
Paracelis, Mountain Province
Hotline No. 0998 598 7837

PMPSIN
Subject: Police Report

TO WHOM IT MAY CONCERN:

THIS IS TO CERTIFY that based on record dated May 30, 2024, the following
data exists and is extracted to read:

“REPORT re LOSS OF PASSPORT” On May 30, 2024 at about 12:51 PM,

MS. PRESENTACION D. MATIB, of legal age, Filipino citizen with postal address at
Poblacion, Paracelis, Mountain Province personally appeared before this police
station and requested to put into records that her PHILIPPINE PASSPORT issued by
the Department of Foreign Affairs was unintentionally lost. Reporting person stated
during inquiry that sometime on May 10, 2024 while she was doing some errands,
she noticed that the pouch containing said passport got lost. Subject item might have
been dropped from the taxi she rode home. Accordingly, above-named reporting
person averred among others that the same was not sold, transferred, mortgaged
nor encumbered to any person and that she exerted effort to locate the same but it
proved futile. (Attached is the duly notarized AFFIDAVIT OF LOST of the reporting
person forming part of this report).

This certification is issued upon request of the above-named person this 30 th

day of May 2024 for legal intent it may serve.

PMSg Glenn F Edchamag

Duty Invest PNCO