REPUBLIC OF THE PHILIPPINES )

City of Cebu ) S.S.

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AFFIDAVIT OF LOSS

I, MARIE JANE PAJAR, of Legal Age, Filipino, single, with residential

address at CANDUMAN, MANDAUE CITY, Philippines, subscribing under oath,
hereby depose and state:

1. That I lost my Philippine Passport;

2. That I could no longer recall where I lost it because I had several
transactions with the bank and through Palawan Express Padala about 2
weeks ago;
3. That I also used my passport as a valid ID when I would go home to
Davao, I presented the same passport as proof of identification;
4. When I discovered just recently that my passport was missing when I
arrived my apartment in Canduman, Mandaue City. I tried to look for it
and I called the taxi operator (KEN Taxi) that drove me home as to
whether a Philippine Passport was left behind by a passenger, however,
the operator replied that the driver has not reported a left behind
Philippine Passport;
5. That my search became futile. Despite diligent efforts to locate the same,
it could no longer be located and I declare that it is lost for all legal intent
and purposes;
6. The details of my passport are as follows: Passport Number EC6337688
valid until January 6, 2021;
7. That I certify this under oath to report the loss of my Philippine Passport
issued in my name to avoid/prevent it from being used for illegal
purposes by other persons;
8. That I execute this affidavit to attest to the truth of all the foregoing facts.

IN WITNESS WHEREOF, I have hereunto set my hand this 15th day of

May 2018, in the City of Cebu, Philippines

MARIE JANE PAJAR

Affiant
UMID No. CRN-0111-7743215-7

SUBSCRIBED AND SWORN to before me this 15th day of May 2018 at

the City of Cebu, Philippines.

ATHENA M. SALAS
Doc. No. _____; Notary Public
Page No. _____; Until December 31, 2018 in Cebu
Book No. _____; Notarial Commission No. 05-17; 01-10-17
For Cebu City, Carcar City, and the Municipality of San Fernando, Cebu
Series of 2018.
PTR No. 176550; 01-03-18; Cebu Province
IBP No. 015117; Lifetime; Cebu City
Attorney’s Roll No. 65125
TIN No. 251-136-923-000
MCLE Compliance No. 0005078 valid until April 14, 2022
Room 206 Aniceta Bldg. Osmeña Blvd. Cebu City