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AFFIDAVIT OF LOSS
(Re; Philippine Passport)
3. I exerted diligent effort to locate the said PHILIPPINE PASSPORT but the same
could no longer be found and hence the passport is considered forever lost;
4. Said PHILIPPINE PASSPORT was never given nor pledged to anyone for any
purpose whatsoever, nor was it taken or confiscated by the authorities for any
violation of the law;
IN WITNESS WHEREOF, I have hereunto set my hand this 29th day of April, 2017
at Baguio City, Philippines.
HEIDI Q. DACORON
AFFIANT
PhilHealth ID No. 04-050061638-7
SUBSCRIBED AND SWORN TO before me this 29th day of April, 2017 at Baguio
City, Philippines. Affiant personally appeared before me and to be the same person who
executed this instrument freely and voluntarily.
MODESTO T. ANDONG
Notary Public
Commission No. 35-NC-16-R/Until: December 31, 2017
PTR No. 2945281/01-05-2017/Baguio City
IBP No. 1056844/01-05-2017/Baguio-Benguet Chapter
Roll No. 31289/5-15-81/Manila
Doc. No. 371; MCLE COMPLIANCE No. VI-0000192/June 14, 2016
Page No. 75; BIR TIN No. 121-017-652
Book No. XXII; No. 19, 2nd Floor Old Market Bldg.,
Series of 2017. Magsaysay Ave., Baguio City, Philippines