Republic of the Philippines )

City of Puerto of Princesa )S.S.

x-------------------------------------x

AFFIDAVIT OF MUTILATION PHILIPPINE PASSPORT

I, YEE HIN CHUA, of legal age, married, Filipino citizen, and presently residing
at Unit 3 Zen Residences, Getsemane Rd., Casuntingan, Mandaue City, Cebu, 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. EB6748245 issued on November 13,

2012 by the Department of Foreign Affairs in Cebu;

2. That the said passport was damaged/mutilated because it accidentally got wet
when I was in a tour in Thailand;

3. That the damage on the said passport has rendered it unusable for travel purposes
and therefore I request the Department of Foreign Affairs to issue a replacement
passport in my favor; and,

4. That I attest to the veracity of the foregoing information.

IN WITNESS WHEREOF, I have hereunto set my hand this 11th day of August
2017 at Puerto Princesa City, Philippines.

YEE HIN CHUA

Affiant
Passport No. EB6748245

SUBSCRIBED AND SWORN to before me this 11th day of August 2017 in Puerto
Princesa City, Philippines, affiant exhibiting to me his competent evidence of identity
details of which are shown below his name and signature.

Doc. No.:________
Page No.:________
Book No.:_______
Series of 2017.