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Affidavit of Loss of Passport

Josefina G. Diwa, a Filipino widow, has lost her Philippine passport which she kept in a pouch inside her room cabinet. After moving to a new house and renovating the old one, she discovered the pouch was missing and has made efforts to locate it without success. She is executing this affidavit to confirm the loss for the purpose of obtaining a new passport.

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Belle Diwa
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10 views1 page

Affidavit of Loss of Passport

Josefina G. Diwa, a Filipino widow, has lost her Philippine passport which she kept in a pouch inside her room cabinet. After moving to a new house and renovating the old one, she discovered the pouch was missing and has made efforts to locate it without success. She is executing this affidavit to confirm the loss for the purpose of obtaining a new passport.

Uploaded by

Belle Diwa
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines )

Province of )
_____________________) S.S.
x---------------------------------x

AFFIDAVIT OF LOSS PASSPORT

I, JOSEFINA G. DIWA, of legal age, widow, Filipino, with postal address at 50


Purok 2, San Matias Lubao, Pampanga, after having been sworn to in accordance with
law, hereby depose and state that:

1. I am a holder of a Philippine Passport issued by the Department of Foreign


Affairs in City of San Fernando, Pampanga and I acquired it when I was about
20-25 years old. Exact date of application and other relevant information of
the card were already unknown to me.

2. Thereafter, I kept my passport in a small pouch and put the pouch inside my
room cabinet.

3. In 2010, we moved into a new house and said cabinet was left in our old
house. The old house was renovated in 2015.

4. When I went back to our old house, I noticed that the pouch carrying my
passport is no longer inside the cabinet.

5. I took earnest efforts to locate my pouch but to no avail. I believe that it was
misplaced or must have kept in another place without me noticing it; hence, I
gave up and considered it as lost.

6. I execute this affidavit to attest to the truthfulness and veracity of the


foregoing facts, and for the purpose of securing another Philippine
Passport, and for whatever purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of March
2025 in Manila, Philippines.

JOSEFINA G. DIWA
Affiant

SIGNED IN THE PRESENCE OF:

________________________ _________________________

SUBSCRIBED AND SWORN to before me this ____ day of ____________ 2025


at __________________, affiant exhibited to me his Driver’s License with ID No.
_____________________, as competent evidence of his identity.

Doc. No. ________;


Page No. ________;
Book No. ________;
Series of 2025.

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