REPUBLIC OF THE PHILIPPINES

CITY OF MALABON S.C.

AFFIDAVIT OF LOSS
I, Krizia Marie Marquez Dela Cruz, single, Filipino, of legal age and a resident of
Malabon City, Manila, after having been duly sworn to in accordance with law do
hereby depose and state that:
1. I am an owner of a Passport, issued by the DFA Philippines, at Manila Branch (DFA
SM Manila)
2. The said passport lost in my possession on how, when or where for which I cannot
determine for sure;
3. I took pains, and exerted due diligence and earnest efforts to look and locate for the
above mentioned passport but to no avail and consider the same as lost;
4. I am executing this affidavit to attest to the truth of the above statement of facts and
for whatever legal purposes this may serve;
IN WITNESS WHEREOF, I have hereunto set my hands this day 14th of May, at
Malabon district police office.

Affiant
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SUBSCRIBED AND SWORN to before me today, _______________________ here at

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