Download as DOC, PDF, TXT or read online from Scribd
Download as doc, pdf, or txt
You are on page 1/ 2
REPUBLIC OF THE PHILIPPINES)
GENERAL SANTOS CITY ) S.S.
AFFIDAVIT OF LOSS
I, MARY ANN CUBITA VILLASAN, of legal age, widow, Filipino, with residence at Purok 28, Gawan, San Jose, General Santos City, after having been sworn to in accordance with law hereby depose and state that:
The undersigned was issued a Philippine Passport by the Department of Foreign Affairs (DFA) in the Philippine Embassy of Doha with the following details:
Philippine Passport No: P3437299C;
Date of Issue: March 2, 2023; and Issuing Authority: Philippine Embassy of Doha.
The said passport was lost on June 14, 2024, while I was traveling from Koronadal City to General Santos City. I placed it inside my bag, and unfortunately, it fell without my knowledge while in transit;
The undersigned exerted all efforts possible to locate the said passport, but to no avail;
The undersigned fully understands that the said passport is automatically deemed canceled upon declaration of loss and that if found, it can no longer be used; and
The undersigned is executing this Affidavit of Loss in connection with her present application for a new Philippine passport.
That further Affiant sayeth none.
IN WITNESS WHEREOF, I have hereunto set my hand this June 21, 2024, in General Santos City, Philippines.
MARY ANN CUBITA VILLASAN
Affiant
SUBSCRIBED AND SWORN to before me this June 21, 2024, in General
Santos City, Philippines. Affiant exhibited to me her competent evidence of identity, UMID ID No. CRN-0111-9154516-9.
ATTY. OWEN LADAO MARAASIN
Notary Public UNTIL DECEMBER 31, 2025 PNC NO. 24-292/TIN 328-112-521-000 DOC. NO. 11; PTR NO. 1217138A: 05/03/2024 PAGE NO. 4; IBP OR NO. 412488: 1/09/2024 BOOK NO. I; ATTORNEY’S ROLL NO. 91457 SERIES OF 2024. MCLE COMPLIANCE EXEMPT UNTIL APRIL 2025 ATTY. OWEN LADAO MARAASIN Notary Public UNTIL DECEMBER 31, 2025 PNC NO. 24-292/TIN 328-112-521-000 DOC. NO. ______; PTR NO. 1217138A: 05/03/2024 PAGE NO. ______; IBP OR NO. 412488: 1/09/2024 BOOK NO. I; ATTORNEY’S ROLL NO. 91457 SERIES OF 2024. MCLE COMPLIANCE EXEMPT UNTIL APRIL 2025
