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AFFIDAVIT

OF LOSS OF PASSPORT
I,

, Filipino citizen, of legal

age and presently residing at


after having been duly sworn to in accordance
with law, hereby depose and state:

1. That I am holder of Philippine Passport No.


2. That sometime around

issued on
, I noted that the said passport was missing.

(date)

3. That to my knowledge, my passport was lost when

(circumstances or event when passport was lost)

4. That I took great pains to look for the said passport but to no avail.
5. That I had reported the loss of the said passport to the police authority of Singapore.

IN TRUTH WHEREOF, I have hereunto signed my name below this day of


at the Embassy of the Philippines in Singapore.

Affiant
Full Name and Signature

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