REPUBLIC OF THE PHILIPPINES)

QUEZON CITY ) S.S.

AFFIDAVIT OF LOSS

I, CORAZON L. BALITA, of legal age, Filipino, and with address at

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

That I am the holder of PASSPORT ID issued by DFA;

That unfortunately the above-mentioned PASSPORT ID was lost on September 22, 2015
when it was accidentally lost and despite diligent effort to locate the same but effort found futile;

That I am executing this affidavit in order to attest the truth of the foregoing facts and for
all legal intents it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 29 th day of September

2015 at Quezon City, Philippines.

CORAZON L. BALITA
Affiant

SUBSCRIBED AND SWORN to before me this 29th day of September 2015 at Quezon
City, Philippines.

Doc. No.: _______ NOTARY PUBLIC

Page No.: _______
Book No.: _______
Series of 2015
REPUBLIC OF THE PHILIPPINES)
MANILA ) S.S.

AFFIDAVIT OF LOSS

I, LORNA A. ESPOLITA, of legal age, Filipino, and with address at 423 Don Francisco
St. Villa Beatriz Matandang Balara, Quezon City, after having been duly sworn to in accordance
with law, hereby depose and state;

That I am the holder of SIM CARD with No. 0916-392-5487 issued by GLOBE
TELECOM;

That unfortunately the above-mentioned SIM CARD was lost on January 12, 2014 due to
snatch incident together with my bag and despite diligent effort to locate the same but effort
found futile;

That I am executing this affidavit in order to attest the truth of the foregoing facts and for
all legal intents it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 13th day of January 2015 at
Manila, Philippines.

LORNA A. ESPOLITA
Affiant

SUBSCRIBED AND SWORN to before me this 13th day of January 2015 at Manila,
Philippines.

Doc. No.: _______ NOTARY PUBLIC

Page No.: _______
Book No.: _______
Series of 2015