Republic
of the Philippines )
City
of _____________ )
S.S
AFFIDAVIT OF LOSS
I, (NAME OF AFFIANT), of legal age, Filipino, single/married, and a resident of (Place of Residence),
after having been duly sworn to according to law hereby depose and state:
1. That I am the parent of minor child (NAME OF CHILD), born on (Date of Birth of Child), who lost her Philippine passport
issued by the Department of Foreign Affairs in 2017;
2. That because it was lost, details of the passport
like passport number and specific date of issue and validity are beyond memory;
3. The said passport was discovered lost in 2019 while
we were recalling through our documents. It was in all probability misplaced when we were
transferring residence from Manila to
Cebu along with our various personal belongings sometime around 2017;
4. That I exerted diligent effort in locating the said
lost passport, but to no avail;
5. That I have the following attached birth
certificate of my child to support my claim that my child is a citizen of the
Philippines;
6. That I am executing this affidavit to request the Department
of Foreign Affairs and/or appropriate government agencies to issue my child a
new passport, and;
7. That I attest to the veracity of the foregoing
information.
IN WITNESS
WHEREOF, I have hereunto set my hand this ____________________ at Cebu City,
Philippines.
(NAME OF AFFIANT)
SUBSCRIBED
AND SWORN TO BEFORE ME this _____________________, in the City of __________,
Philippines by (Name of Affiant) who
presented her LTO Driver’s License No. ________________, a government-issued
ID bearing her name, signature and photograph.
Doc.
No. _____;
Page
No. _____;
Book
No. _____;
Series
of _____.
