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    Sample Affidavit of Loss of Passport



    REPUBLIC OF THE PHILIPPINES)
    CITY OF MAKATI                   ) S.S.
    x----------------------------------x
      

    AFFIDAVIT OF LOSS 


       I, ___________________, of legal age, Filipino, single and a resident of _______________________________, after having been duly sworn to in accordance with law, depose and state THAT:

    1. On January 12, 2010, I was issued a Philippine Passport by the Department of Affairs in Manila;

    2. Recently, I had tried to look for the said passport but the same could not be found;

    3. Despite diligent search and efforts to locate the said passport, I could not find the same such that I believe that it is now lost beyond recovery; 

    4. As such, I am executing this affidavit to attest to the foregoing facts and to support the application for the issuance of a new one in lieu of the one which was lost. 

    IN WITNESS WHEREOF, I have hereunto set my hand this ___________________ in Makati City, Metro ManilaPhilippines.





    ____________________
    Affiant
    GSIS ID No. _____________


      SUBCRIBED AND SWORN TO before me this ___________________ in _________________Philippines, affiant exhibiting to me his valid proof of identification.

    Doc. No. _____;
    Page No. _____;
    Book No. _____;
    Series of 2013.

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