A F F I D AV I T

(TO EXPLAIN LOSS/DESTRUCTION OF PHILIPPINE PASSPORT)

AFFIANT: (Please type/print legibly all information requested)

NAME: _______________________________________________________________________
(First Name) (Middle Name) (Last Name/Surname)

Date of Birth: _______________________ Place of Birth:

______________________

Civil Status: (___) Single (___) Married (___) Divorced

(___) Separated (___) Widow (er)

Residence: ________________________________ Tel.# : _____________________________

Passport No. :_____________________ Date of Issue :_______________________________

Place of Issue:_________________________________________________________________

after being sworn according to law, depose and say:

1. That I am a Philippine citizen and holder of Philippine passport described above:

2. That the said passport was (check appropriate box) was (__) lost (__) destroyed
under the following circumstances
(State when, where and how passport was lost or destroyed. If space below is not
sufficient, use reverse side):

___________________________________________________________________________________
__________________________________________________________________________________
__

___________________________________________________________________________________

___________________________________________________________________________________

3. That efforts were exerted to locate the lost passport, but in spite of diligent
search, it could not be found and the same is now beyond recovery. (This
paragraph is not applicable to destroyed passport)

4. That I need a new passport urgently for the following reasons:

__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

5. That in view of the foregoing explanation, it is requested that a new passport be

issued to the undersigned, in lieu of the (__) lost (__) destroyed passport, subject
to compliance with prescribed requirements.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ___________ at Vancouver,

B.C., Canada.

________________________
Affiant

SUBSCRIBED AND SWORN to before me this _____________________ at the Philippine Consulate

General, Vancouver, B.C., Canada.

AFFIANT exhibiting to me his/her identification document:

__________________________
Signing Officer

Doc. No. : _______

Book No. : _______
Page No. : _______
Series : _______
Service No. : _______
Fee : _______
REPUBLIC OF THE PHILIPPINES)
CITY OF _______ )S.S.
X - - - - - - - - - - - - - - - - - - - - - - - -X

AFFIDAVIT OF LOSS

I, ___________, Filipino, of legal age, single/married and a resident of

__________________________, Philippines, after having duly sworn to in accordance
with law, hereby depose and say that:
1. I am a holder of a student Identification Card issued by
_____________________________ ;
2. I lost said Identification Card on ____________________ and that I exerted all
efforts to locate the same but I could not remember exactly where I placed/left it
and it is considered lost for all legal purposes;
3. Said Identification Card was not confiscated by any officer of the law or the
officers of (name of school) by reason of any violation of any law, ordinance,
presidential decree or rules and regulation of said university; and neither was it
offered as collateral for any loan;
4. I am executing this affidavit to attest to the foregoing facts;
IN WITNESS WHEREOF, I have hereunto set my hand this ______________ in
the City of _____________, Philippines.

________________
Affiant

SUBSCRIBED AND SWORN to before me this _______________ in the City of

__________, Philippines, affiant having exhibited to me his/her community tax
certificate with no. __________________ issued on _________________ at
______________ .

Doc. No. ________;

Page No. ________;
Book No.________;
Series of 2006.