AFFIDAVIT OF LOSS OF PASSPORT
The
undersigned,
Filipino
citizen,
single/married,
presently
residing
at
____________________________________________________ after having duly sworn to in
accordance with law, hereby deposes and says:
That the undersigned was issued Philippine Passport No. ________________ by the
Department
of
Foreign
Affairs
in
Manila/Consular
Extension
Office/Philippine
Embassy/Consulate in ___________________ on ___________________________;
That said passport was lost on _____________________ under the following
circumstances:
That the undersigned exerted all efforts possible to locate said passport to no avail;
That the undersigned fully understands that the said passport is automatically deemed
cancelled upon declaration of loss, and that if found, it can no longer be used;
That undersigned is executing this affidavit of loss in connection with his/her present
application for a new passport;
That further Affiant/s sayeth none.
IN WITNESS WHEREOF, undersigned hereby affixes his/her signature this
______________ day of _____________ in _________________, USA.
_____________________________
Affiant
SUBSCRIBED AND SWORN to before me this _________ day of ______________
in _________________, USA. The Affiant having exhibited to me his/her Identification card No.
_______________ issued on ___________________ at _________________________.
_________________________________
Administering Officer/Notary Public