REPUBLIC OF THE PHILIPPINES )
Caloocan City, Metro Manila ) S.S.
x--------------------------------------------------x
AFFIDAVIT OF LOSS
OF PASSPORT
I, ALICIA ACHICO AMORES, of legal age, Filipino citizen, single and
presently residing at 30E T. Gener St., Kamuning, Quezon City after being duly sworn to
in accordance with law hereby depose and state:
That the undersigned exerted all efforts possible to locate or retrieve said
passport but to no avail.
That the undersigned fully understands that the said passport is
automatically deemed cancelled upon declaration of loss, and that if found, can no longer
be used.
That the undersigned is executing this affidavit of loss for the information of
all the duly constituted authorities and for the purpose of applying for the issuance of new
passport or travel document.
That further affiant/s sayeth none.
IN WITNESS WHEREOF, undersigned hereby affixes her signature this
25 day of July 2022 at Caloocan City, Metro Manila, Philippines.
th
ALICIA ACHICO AMORES
Affiant
SUBSCRIBED AND SWORN to before me this ______day of July 2022 in
Caloocan City, Metro Manila, Philippines. The Affiant having exhibited to me her
____________________issued by the ____________________.
NOTARY PUBLIC
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2022.