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REPUBLIC OF THE PHILIPPINES}

DONE: IN THE CITY OF BAGUIO} S.S.


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

AFFIDAVIT OF LOSS

I, CHERRY BITANGKOL BALANAG, of legal age, Filipino Citizen, married and


currently residing at Simsim Compound, Maria Basa St. Pacda, Baguio city, Philippines,
after having been duly sworn in accordance with law, depose and state:

1. I was issued by the Department of Foreign Affairs a passport sometime in the


year 2012 which shall expire in 2017;

2. I have kept the said passport with my other significant documents in a folder;

3. Last 2003, we resided in an apartment located in Rimando Rd., Baguio City,


but have to transfer again to another apartment located in New Lucban, Baguio
City last 2014, in 2015, however, we moved to our current residence at Simsim
Compound, Maria Basa St., Pacdal, Baguio City.

4. During that span of we were required to transfer our things from one apartment
to another, I have misplaced the said folder were I kept my passport and other
significant documents.

5. Despite diligent efforts I exerted to recover the said passport, the same was
proved to be futile and fruitless, hence, I considered it lost and beyond point of
recovery;

6. The abovementioned passport was neither confiscated for violation of any law,
rules or regulations nor was it delivered to an person to guaranty the
performance of any obligation;

7. I am now executing this document to verify the veracity of the foregoing


narration for securing a replacement for the said lost passport and for all legal
intent and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 15th day of January
2017, in the City of Baguio, Philippines.

_____________________________
CHERRY BITANGKOL BALANAG
Affiant
SUBSCRIBED AND SWORN to before me, in the City of Baguio, Philippines, this
15th day of January 2017, by Cherry Bitangkol Balanag, who satisfactorily proven
her identity through her Social Security System ID No. 33-5550485-0, that she is
the same person who personally signed the foregoing affidavit before me and
acknowledged that she executed the same. That I have avowed under the penalty
of law to the whole truth of this document.

MELFORD A. LAPNAWAN

Notary Public
Until December 31, 2017
Tel No.: (074) 442-8931
PTR No. 2198282, 04-30-18 Baguio City, Benguet
IBP O.R. No. 1008288, 4-14-18
Roll No. 04789, 04-29-18
Doc. No. 5; Commission Serial No.: 74-NC-12 (R)
MCLE Compliance No. II-0002267, 01-15-19
Page No. 1; TIN 428-986-655
Rm. 2, Nova Lodge Marcos Highway, Baguio
Book No. I;
Series of: 2017
Series of 2016