REPUBLIC OF THE PHILIPPINES
CITY OF MAKATI )
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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 Manila, Philippines .
____________________
Affiant
GSIS ID No. _____________
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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.