REPUBLIC OF THE PHILIPPINES

CITY OF CALAPAN, PROVINCE OF

ORIENTAL MINDORO

AFFIDAVIT OF LOSS

I, Sharon Cuneta, of legal age, Filipino, married and a resident of Corregidor

St. San Vicente West, Calapan City Oriental Mindoro, after having been duly sworn

to in accordance with law, depose and state:

1. That I am a holder of three Philippine Passports, for me and my 2 children, namely:

1. Sharon Cuneta - affiant
2. Sophia Cuneta
3. Ayessah Cuneta

2. That said Philippine Passports were duly issued in our favor by the Department of
Foreign Affairs in Manila sometime last 2012;

3. That I used to put said passports in the drawer of my house in Las Pinas. But since
we have relocated to Calapan Or. Mindoro in 2014, I have not seen such passports
ever since.

4. That diligent effort to locate the same proved futile;

5. That in view thereof, I now desire and hereby request the Department of Foreign
Affairs, to issue a new passport for us in lieu of the lost one;

6. That I bind myself to save Department of Foreign Affairs, harmless from any loss or
damage that it may incur in connection with the issuance of a new Philippine
Passports in lieu of the lost one;

7. That I am executing this affidavit to attest to the foregoing facts and for any legal
purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of January
2018 in Calapan City, Oriental Mindoro, Philippines.

Sharon Cuneta
Affiant

SUBCRIBED AND SWORN TO before me this __ day of January 2018, in Calapan

City, Oriental Mindoro, Philippines, affiant exhibiting to me his valid proof of
identification.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2018.