Republic of the Philippines )

Camiling, Tarlac
) S.S

AFFIDAVIT OF LOSS
I, MICHAEL V. LIMBATING, of legal age, Filipino citizen, and a resident of
Barangay Sinulatan First, Camiling, Tarlac, Philippines, after having been duly sworn
to in accordance with law, do hereby depose and state THAT:
1. I am a holder of a Philippine Passport and the number of which I could no
longer recall, issued by the Department of Foreign Affairs, San Fernando City,
La Union;
2. I usually keep the said passport, together with my other pertinent documents,
in a brown envelope and use it for identification purposes in every transaction
I make;
3. On November 1, 2013, I took the said envelope and went to the Western
Union Camiling, Tarlac to withdraw some cash;
4. After my transaction, I placed it back inside the said envelope and few
minutes later I went to the Camiling North Cemetery, Camiling, Tarlac to visit
the tomb of my departed relative. Few hours later, I went home;
5. Upon reaching my place, I noticed that the said envelope was missing. I
immediately went back to the Camiling North Cemetery to search for the said
envelope but I found nothing. Also, I asked some of my relatives if they have
seen the same but all answered in the negative;
6. All the diligent efforts exerted to locate the said envelope, containing my
Philippine passport and other personal effects proved futile; hence, I now
consider them as lost and beyond recovery;
7. My passport was never pledged or used to secure any obligation;
8. I am executing this Affidavit to attest to the truth of the foregoing statements
and for all legal intents and purposes it may serve.
IN WITNESS WHEREOF, I hereunto affixed my signature this 30 th day of
October, 2014 at Camiling, Tarlac, Philippines.
MICHAEL V. LIMBATING
Affiant
SUBSCRIBED TO AND SWORN to before me on the date and place
indicated above. Affiant exhibited to me his Employment I.D. with I.D. No. 0016
issued by the Gravitas Pharma Ventures, Urdaneta City, Philippines.