Republic of the Philippines)

Santa Cruz, Laguna ) s.s.

AFFIDAVIT OF LOSS
OF PHILIPPINE PASSPORT

I, FLORDELIZA M. MORALES, of legal age, Filipino, married and a

resident of Brgy. San Juan, Santa Cruz Laguna, after having been duly
sworn to in accordance with law, depose and state THAT:

1. On our about the year 1998, I was issued a Philippine Passport by the
Department of Affairs in Manila;

2. Recently, I tried to look for the said passport but the same could not be
found anymore as it was inadvertently lost;

3. 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;

4. As such, 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 WHEREFORE, I have hereunto set my hand this 17

September 2016 in Santa Cruz, Laguna, Philippines.

FLORDELIZA M. MORALES
Affiant

SUBSCRIBED AND SWORN to before me this 17 September 2016 by

the affiant with Senior Citizen Id. No. 13-1174, issued at Santa Cruz, Laguna
issued on 29 October 2013.

Doc. No. _____; A T T Y. E M M A N U E L E . S A N D I C H O

Page No._____; NOTARY PUBLIC, COMMISSION UNTIL 31 DEC. 2016
Book No._____; NOTARY PUBLIC FOR THE PROVINCE OF LAGUNA
Series of 2016. PER NOTARIAL COMMISSION SP. PROC. NO. 164(15)
IBP O.R. No. 995689, 04 January 2016, Laguna Chapter
PTR O.R. No. 2967138, 04 January 2016, Laguna
Roll No. 42246, admitted to practice law on 9 May 1997
MCLE Compliance No. V-0015412, dated 6 March 2016