Republic of the Philippines )
) S.S
AFFIDAVIT MUTILATION
I,, a 46-year-old resident of Brgy. , Philippines, a Filipino, after having been
sworn to in accordance with law, hereby depose and state that:
1. That I am a holder of Philippine Passport No. DD56 issued on October 02,
1998 by the Philippine Embassy Singapore;
2. That the said passport was damaged/mutilated due to the recent typhoon;
3. That the damage on said passport has rendered it unusable for travel
purposes. Hence, I am executing this affidavit for the issuance of a
replacement passport in my favor;
4. That I attest to the veracity of the foregoing information.
IN WITNESS WHEREOF, I have hereunto set my hand this ____________at
Affiant
SSS No. 33-79136
SUBSCRIBED AND SWORN TO before me this ___________ at Philippines.
Affiant exhibiting to me her competent proof of identity indicated below her
name and signature.