REPUBLIC OF THE PHILIPPINES)
TAGUIG CITY )S.C.
AFFIDAVIT OF MUTILATION
I, JASHA ORDIZ TAMAYO, of legal age, single, Filipino, and a resident of 425 5 th St.,
GHQ Village, Brgy. Katuparan, Taguig City, Metro Manila, Philippines, after having been duly
sworn to in accordance with law do hereby depose and state the following:
1. That I was duly issued a Philippine Passport with Number P2253826B by Department
of Foreign Affairs Manila on 23 May 2019 and will expire on 22 May 2029;
2. That I safe keep the said item;
3. That however, sometime on April 2023, I found out that the first page (1 and 2) of
said Passport was torn, hence, it was damage/mutilated;
4. That the damage on the said Passport has rendered it unusable for travel purposes and
therefore I request the Department of Foreign Affairs the replacement of said Passport
in my favor;
5. That I executed this affidavit to attest to the truth of the foregoing and for whatever
legal intents and purposes it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed my signature this
July 30, 2024, at Taguig City, Philippines.
JASHA ORDIZ TAMAYO
Affiant
SUBSCRIBED AND SWORN TO before me this July 30, 2024, at Taguig City, Metro
Manila, Philippines. Affiant personally known to me and was identified by me through
competent evidence of identity as defined in the 2004 Rules of Notarial Practiced (A.M. No. 02-
8-13-SC). The affiant exhibited to me her Philhealth ID with her photograph and signature
appearing thereon bearing No. 01-026404139-8.