AFFIDAVIT OF LOSS OF PASSPORT

I, Fruze Kim N. Serate, Filipino citizen, of legal age and presently residing at
Tudtud Compound, Cabancalan, Brgy. Talamban Cebu City after having been
duly sworn to in accordance with law, hereby depose and state:

1. That I am holder of Philippine Passport issued under my name at Cagayan

de Oro Office of the Department of Foreign Affairs.
2. That sometime around August 2017, I noted that the said passport was
missing.
3. That to my knowledge, my passport was lost when a fire broke at my family
home in 56 Rose Avenue, Pilar Village Subdivision, Las Piñas City.
4. That I took great pains to look for the said passport but to no avail.

IN WITNESS WHEREOF, I hereunto set my hand this 6th Day of February

2018 in Cebu City, Philippines.

Kim Fruze Serate

Affiant
SSS ID: 08-0822872-5

SUBCRIBED AND SWORN TO before me this 24th day of November 2017 in

Cebu City, Philippines, affiants exhibiting to me his valid proof of identification:
SSS ID ( No.08-0822872-5).

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