REPUBLIC OF THE PHILIPPINES}

BATANGAS CITY} S.S.

AFFIDAVIT OF LOSS

I, ROMINA C. MARANAN, married, of legal age, Filipino and a resident of 347 Dalig,
Batangas City, after having been duly sworn according to law depose and say, That:

[1] I am the holder of Philippine Passport No. EB8306053 issued by the Department of
Foreign Affairs, Batangas City on June 04, 2013;

[2] On May, 2017, while I was organizing my papers and documents, I noticed that my
said Philippine Passport was missing;

[3] I had tried to look for the said passport but the same could not be found;

[4] 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;

[5] 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 22 nd day of January, 2018 at
Batangas City.

ROMINA C. MARANAN
Affiant
Techno Prints ID. No. 001

SUBSCRIBED AND SWORN to before me this 22nd day of January 2018 at Batangas City,
Philippines, affiant exhibited to me her Identification Id card with No. stated-above.

SONNY JOSE M. RICABLANCA

Notary Public
Until 31 December 2018
PTR No. 3022119 01-03-18 Batangas City
Doc. No. 321; IBP No. 1065629 Batangas City
Page No. 66; Roll No. 69544 Serial No. 2017-20
Book No. I MCLE Exempted, pursuant to MCLE Governing Board Order
Series of 2018. No. 1, S.2008
Zenaida Arcade, 43 M.H. del Pilar St., Batangas City