REPUBLIC OF THE PHILIPPINES )

Las Piñas City ) ss.

AFFIDAVIT OF LOSS

I, OLIVIA B. ATIENZA, of legal age, Filipino, married and a

resident of Block 2 Lot 10 Ma. Felicidad Luis St., BF Resort Village
Talon Dos, Las Piñas City, under oath declare that:

1. I am the holder of Philippine Passport No. EB9743980 issued

by the Department of Foreign Affairs, NCR South on December
4, 2013.
2. On March 6, 2018 I misplaced my bag where I kept my said
passport.
3. I took pains to look for my said bag but to no avail.
4. Despite diligent search and efforts to locate my said passport, I
could not find the same and is now considered as lost and
beyond recovery.
5. I am executing this Affidavit of Loss to attest to the truthfulness
and veracity of the foregoing statements; and to be issued a new
passport in lieu of the one that was lost.

I have affixed my signature on this 14th day of March 2018 in Las

Piñas City.

OLIVIA B. ATIENZA
Affiant

SUBSCRIBED AND SWORN to before me on this 14th day of

March 2018 with affiant exhibiting to me her Driver’s License No N
187016794 issued at Land Transportation Office, until March 3,
2022.
Witness my hand and seal.

NOTARY PUBLIC

Doc. No.
Page No.
Book No.
Series of 2018.