Republic of the Philippines )

City of Pasay ) S.S.

x-----------------------------------------------x

AFFIDAVIT OF LOSS

I, Joahna Maria Benitez, of legal age, Filipino, single, and a resident of 143 Corinthian
St, Greenmeadows Subdivision, Pasig City, Philippines, after having been duly sworn in
accordance with law, hereby depose and state:

That on 23 April 1980, I was issued a Philippine Passport by the Department of Foreign
Affairs in Manila;

That recently I had tried to look for the said passport but the came could not be found;

That despite diligent search and efforts to locate the said passport, I could not find the
same such that I now believe that it is now lost beyond recovery;

As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing and to
support the application for the issuance of new one in lieu of the one which was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this 28 th day of January 2018 at
Pasay City, Philippines.

Joahna Maria Benitez

Affiant

SUBSCRIBED AND SWORN to before me this 29 th day of January 2018 in Manila,

Philippines. The Affiant having exhibited to me his/her Identification Card No.1678-2016
issued on 01 July 2013 at Pasay City.

Notary Public

Doc. No. ______;

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