REPUBLIC OF THE PHILIPPINES )
PROVINCE OF ________________________ )
CITY OR MUNICIPALITY OF ________________________ )S.S.
AFFIDAVIT OF DESTRUCTION OR MUTILATION
I, ________, of legal age, Filipino, single, and presently residing at ________, after having been duly sworn to in accordance with law, do hereby depose and state that:
1. I am the owner of a Philippine Passport which was issued at DFA Angeles (the "Passport");
2. The Passport was destroyed or mutilated in the following manner:
________
3. 552 25882252 852 22 822225 82 5825 225 255828 25522828 552 22 252 52825582822 25 2528852822;
4. I am executing this affidavit to attest to the truth of the foregoing, to request for a replacement of my passport from the Department of Foreign Affairs and for all legal purposes it may serve.
8225885 2585858 588558 885285.
IN WITNESS WHEREOF, I have hereunto signed this Affidavit this _________ day of ______________________, 20______ at CITY OR MUNICIPALITY OF ________________________, ________________________.
________
Affiant
SUBSCRIBED AND SWORN TO BEFORE ME this _________ day of ______________________, 20______ at CITY OR MUNICIPALITY OF ________________________, ________________________ affiant, ________, personally appeared before me and exhibited to me their Driver's License no. ________ which is valid until ________.
Doc. No.: _________
Page No.: _________
Book No.: _________
Series of _________
REPUBLIC OF THE PHILIPPINES )
PROVINCE OF ________________________ )
CITY OR MUNICIPALITY OF ________________________ )S.S.
AFFIDAVIT OF DESTRUCTION OR MUTILATION
I, ________, of legal age, Filipino, single, and presently residing at ________, after having been duly sworn to in accordance with law, do hereby depose and state that:
1. I am the owner of a Philippine Passport which was issued at DFA Angeles (the "Passport");
2. The Passport was destroyed or mutilated in the following manner:
________
3. 552 25882252 852 22 822225 82 5825 225 255828 25522828 552 22 252 52825582822 25 2528852822;
4. I am executing this affidavit to attest to the truth of the foregoing, to request for a replacement of my passport from the Department of Foreign Affairs and for all legal purposes it may serve.
8225885 2585858 588558 885285.
IN WITNESS WHEREOF, I have hereunto signed this Affidavit this _________ day of ______________________, 20______ at CITY OR MUNICIPALITY OF ________________________, ________________________.
________
Affiant
SUBSCRIBED AND SWORN TO BEFORE ME this _________ day of ______________________, 20______ at CITY OR MUNICIPALITY OF ________________________, ________________________ affiant, ________, personally appeared before me and exhibited to me their Driver's License no. ________ which is valid until ________.
Doc. No.: _________
Page No.: _________
Book No.: _________
Series of _________
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