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Republic of the Philippines)

Province of Bohol )
City of Tagbilaran )

AFFIDAVIT OF LOSS

I, MA. CORAZON B. ADAPTAR, of legal age, Filipino, single


and a resident of Purok 7, Mayacabac, Dauis, Bohol, Philippines,
after having been duly sworn to in accordance with law do hereby
depose and say:

That, on April 23, 2007, I applied for Registration with the


Office of the Commission on Election, Dauis, Bohol Application No.
1219300001505 VIN 1219-0017C-D0188MBA 20000-5 and
ultimately, I received said Identification Card which I kept in my
boarding house in Tawala, Panglao, Bohol;

That, when I transferred all my things to my residence in


Purok 7, Mayacabac, Dauis, Bohol sometime in July, 2013, said
identification card could no longer be found;

That, I exerted diligent effort to locate the same but in vain for
it could never be found, hence, I considered the same to have been
definitely lost beyond recovery;

That, I am executing this affidavit to support the loss of my


COMELEC IDENTIFICATION CARD with the request upon the
authorities concerned that I be issued a new identification card in
lieu of the lost one;

IN WITNESS WHEREOF, I hereunto affix my signature this


______________ day of October, 2013 at the City of Tagbilaran,
Philippines.

MA CORAZON B. ADAPTAR
Affiant

SUBSCRIBED and SWORN TO before me this


___________________ affiant exhibited to me her SSS ID No.
_____________________ this __________________________ at
the City of Tagbilaran, Philippines.
Republic of the Philippines)
Province of Bohol )
City of Tagbilaran )

AFFIDAVIT OF LOSS

I, MA. CORAZON B. ADAPTAR, of legal age, Filipino, single


and a resident of Purok 7, Mayacabac, Dauis, Bohol, Philippines,
after having been duly sworn to in accordance with law do hereby
depose and say:

That, sometime in 2009, I was issued a PASSPORT;

That, I left the same in my boarding house in Tawala, Panglao,


Bohol;

That, when I returned home I brought along with me all my


things among which was my PASSPORT which I later on discovered
to have been lost;

That said PASSPORT has never been confiscated for any


violation whatsoever;

That, despite diligent effort exerted to search the same it


turned futile as it could no longer be found hence, I considered the
same to have been definitely lost beyond recovery;

That, I am executing this affidavit to support the loss of my


PASSPORT with the request to the proper authorities/agencies
concerned that I be issued a New PASSPORT in lieu of the lost one.

IN WITNESS WHEREOF, I hereunto affix my signature this


______________ day of October, 2013 at the City of Tagbilaran,
Philippines.

MA CORAZON B. ADAPTAR
Affiant

SUBSCRIBED and SWORN TO before me this


___________________ affiant exhibited to me her SSS ID No.
_____________________ this __________________________ at
the City of Tagbilaran, Philippines.