Republic of the Philippines)
Province of ____________________) S.S.
City/Municipality of _____________)
x – – – – – – – – – – – – – x
AFFIDAVIT OF LOSS
I, _____________,of legal age, Filipino, (single / married / widow), and a resident of _____________, Philippines, after having been duly sworn in accordance with law, hereby depose and state:
That on _____________, I was issued a Philippine Passport by the Department of Foreign Affairs in _____________;
That recently I had tried to look for the said passport but the came could not be found;
That despite diligent search and efforts to locate the said passport, I could not find the same such that I now believe that it is now lost beyond recovery;
As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing and to support the application for the issuance of new one in lieu of the one which was lost.
IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at _____________, Philippines.