Read Affidavit of Loss text version

FOREIGN SERVICE OF THE PHILIPPINES ) CONSULATE GENERAL OF THE REPUBLIC OF THE PHILIPPINES) S.S. HONOLULU, HAWAII, U.S.A. )

Affidavit of Loss of Passport

I, ________________________________________________________________________, Filipino, of legal age, single/married to ___________________________________________, and resident of ______________________________________________________________________ __________________________________________________________________________ , after being sworn according to law, hereby depose and say: That I was born on ___________________________ at (city/province/country) of Filipino

____________________________________________________________________

parent(s). My father is (name of father) _______________________________________________, native of (province/city) _______________________________________________________, and my mother is (name of mother) _________________________________________, native of (province/city) _______________________________________________________;

That I applied for and was issued Philippine passport no. _______________________ at ______________________________, on or about _______________________________ ; That this passport is no longer in my possession due to the following circumstances:

(Give detailed account)

__________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ _____________________________________________ That I am executing this affidavit in connection with my present application for a new

Philippine passport in lieu of my lost passport.

FURTHER AFFIANT SAYETH NAUGHT. IN WITNESS WHEREOF, I have hereunto set my hand this _________________ day of ______________________________, _______________ at ______________________.

_________________________

AFFIANT

SUBSCRIBED AND SWORN TO before me this _________ day of ___________________ 20__ at Honolulu, Hawaii, USA. _________________________

Administering Officer

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Affidavit of Loss

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