Embassy of the Philippines

Sample

FOREIGN SERVICE OF THE PHILIPPINES )

EMBASSY OF THE REPUBLIC OF THE PHILIPPINES) S.S.

Berlin,Germany )

AFFIDAVIT OF LOSS

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 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 ______________ 2006 at _____________, Germany.

_________________________ AFFIANT

SUBSCRIBED AND SWORN TO before me this ___ day of ___________________ 2006 at ___________ , Germany.

_________________________

Administering Officer