EMBASSY OF THE PHILIPPINES )
CONSULAR SECTION ) S.S.
TRIPOLI, LIBYA )
AFFIDAVIT OF DESTRUCTION/MUTILATION
I, _______________________, Filipino citizen, of legal age,
single/married, with residence and postal address at
___________________________, Libya, after having been duly sworn
to in accordance with law, do hereby depose and say:
1. That I am a holder of Philippine Passport No. ____________ issued on
___________ by the Philippine Embassy in Tripoli, Libya;
2. That the said Passport was damaged/mutilated due to
______________________________________________________________________
______________________________________________________________________
________________________.
3. That the damage on the said passport has rendered it unusable for
travel purposes and therefore I request the Philippine
Embassy/Consulate to issued a replacement passport in my favor;
and,
4. That I am executing this affidavit to attest to the truth of the
circumstances.
IN WITNESS WHEREOF, I hereby signed this affidavit on this
____day of ______________202_, in the City of Tripoli, Libya.
________________________
Affiant
SUBSCRIBED AND SWORN to before me this ____day of ____________ 202_
at the Philippine Embassy in Tripoli, Libya.
Doc. No. : ……………
Book No. : ……………
Page No. : ……………
Fee : ……………
O. R. No. : ……………
Series of : 202_
/ms
