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A F F I D AV I T OF LOSS
AFFIANT:
Date of Birth: September 5, 1985 Place of Birth: Mainit, Surigao Del Norte
2. That recently, I had tried to look for the said passport but the same could not be found;
3. That efforts were exerted to locate the lost passport, but in spite of diligent search, it could
not be found and the same is now beyond recovery.
4. That I need a new passport urgently for my employment application requirements abroad;
5. That in view of the foregoing reason, it is requested that a new passport be issued to the
undersigned, in lieu of the lost passport, subject to compliance with prescribed requirements.
IN WITNESS WHEREOF, I have hereunto affixed my signature this 12 th day of September 2017, at
Prosperidad, Agusan del Sur, Philippines.
SUBSCRIBED AND SWORN to before me this 12th day of September 2017, at Prosperidad,
Agusan del Sur, Philippines.
Doc. No. :
Book No. : II
Page No. :
Series : 2017
REPUBLIC OF THE PHILIPPINES)
CITY OF _______ )S.S.
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AFFIDAVIT OF LOSS
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Affiant