REPUBLIC OF THE PHILIPPINES )
ZAMBOANGA CITY ) S.S
AFFIDAVIT OF LOSS
I, name, of legal age, Filipino Citizen and a resident of address after having
been duly sworn in accordance with law, hereby depose and state that:
1. That I am the lawful holder of Philippine Passport issued by the Department
of Foreign Affairs, Philippines bearing the Passport Number
__________________;
2. That the said Philippine Passport was missing and misplaced. I tried to locate
the same within our premises but I found nothing.
3. That I diligently exerted efforts to locate the said passport, but despite of
diligent search, it could not be found, hence, the same is deemed lost and at
a point beyond recovery.
4. That the said passport has not been encumbered, sold, pledged, assigned,
alienated, transferred, donated or given as collateral for any debt or
obligation to or in favor of any person or entity;
5. That I understand that my declaration of the above-mentioned passport as
lost shall be construed as satisfactory proof that the passport was lost, in
compliance with Section 15 of RA 8239 of the Philippine Passport Act of 1996.
6. That I am executing this affidavit to attest to the veracity of the foregoing
facts and for whatever legal purpose it may serve under the law.
IN WITNESS WHEREOF, I have hereunto set my hand this 15 th day of January
2025 at Zamboanga City, Philippines.
NAME
Affiant
SUBSCRIBED and SWORN to before me this 15th day of January 2025 at
Zamboanga City, Philippines.
Doc. No.
Page No.
Book No.
Series of 2024.
