REPUBLIC OF THE PHILIPPINES )

Municipality of Paniqui ) S.S

-------------------x

AFFIDAVIT OF LOSS

I, RAMON JOSEPH SANTIAGO CASTILLO, of legal age, Filipino, single and a

resident of Dapdap, Paniqui, Tarlac, after having been duly sworn to in accordance with
law, hereby depos and state:

1. That I am the lawful holder of Philippine Passport issued by the Department

of Foreign Affairs-Manila;
2. That I usually kept the said passport inside my sling bag;
3. That sometime on September 2019, I dropped/lost the above said passport
while riding in a tricycle, from Paniqui, Tarlac town proper going to our home;
4. That I diligently exerted efforts to locate the said passport, but in spite of
diligent search, it could not be found, hence, the same is deemed lost and at
a point beyond recovery;
5. That the said passport has not been encumbered, sold, pledged, assigned,
alienated, transferred, donated, or given as collateral for any debt or obligation
to or in favor of any person or entity;
6. That I understand that my declaration of the abovementioned passport as lost
shall be construed as satisfactory proof that the passport was lost, In
compliance with section 15 or RA 8239 or the Philippine Passport Act of 1996;
7. That I further understand that said passport will be immediately deemed
cancelled and may no longer be used for travel or other purposes. As such, in
case the said passport is found or retrieved, undersigned will immediately
surrender it to the DFA-Manila.
8. That I am executing is affidavit to attest to the veracity of the foregoing facts
and for whatever legal purpose it may serve under law.

IN WITNESS WHEREOF, I have hereunto set my hand this 23rd day of

September, 2019, in the Municipality of Paniqui, Province of Tarlac, Philippines.

RAMON JOSEPH SANTIAGO CASTILLO

Affiant

SUBSCRIBED AND SWORN to before me this 23rd day of September 2019, in the
Municipality of Paniqui, Province of Tarlac.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2019.
REPUBLIC OF THE PHILIPPINES )
Municipality of Paniqui ) S.S
-------------------x

AFFIDAVIT OF LOSS

I, GIGI CANDELARIO DIZON, of legal age, Filipino, single and a resident of

Mayantoc, Tarlac after having been duly sworn to in accordance with law, hereby depos
and state:

1. That I am the lawful holder of Philippine Passport bearing No.__________

issued by the Department of Foreign Affairs-Manila;
2. That sometime in September 2018, said passport was lost inside my bag, I
could not locate the same and I discovered that it was lost/missing. Then, I
tried to look for it and other belongings but I did not find the same;
3. That I diligently exerted efforts to locate the said passport, but in spite of
diligent search, it could not be found, hence, the same is deemed lost and at
a point beyond recovery;
4. That the said passport has not been encumbered, sold, pledged, assigned,
alienated, transferred, donated, or given as collateral for any debt or obligation
to or in favor of any person or entity;
5. That I understand that my declaration of the abovementioned passport as lost
shall be construed as satisfactory proof that the passport was lost, In
compliance with section 15 or RA 8239 or the Philippine Passport Act of 1996;
6. That I further understand that said passport will be immediately deemed
cancelled and may no longer be used for travel or other purposes. As such, in
case the said passport is found or retrieved, undersigned will immediately
surrender it to the DFA-Pampanga.
7. That I am executing is affidavit to attest to the veracity of the foregoing facts
and for whatever legal purpose it may serve under law.

IN WITNESS WHEREOF, I have hereunto set my hand this 19th day of August,
2019, in the City/Municipality of Paniqui, Province of Tarlac, Philippines.

GIGI CANDELARIO DIZON

Affiant

SUBSCRIBED AND SWORN to before me this 19th day of August, 2019, in the
City/Municipality of Paniqui, Province of Tarlac, Philippines, Affiant exhibited to me her
PhilHealth Card No. 07-0258790267-4.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2019.
REPUBLIC OF THE PHILIPPINES )
MUNICIPALITY OF PANIQUI ) S.S
x----------------------------------------------x

AFFIDAVIT OF LOSS

I, JOY FIEBRA ENRIQUEZ, 33 years old, Filipino, married and presently residing
at Purok 4, Brgy. San Isidro, Paniqui Tarlac (with former address at Davao Oriental)
after having been duly sworn to in accordance with law, hereby depos and state:

1. That I am a lawful holder of Philippine Passport issued by the Department of

Foreign Affairs-Manila;
2. That sometime on September 11, 2019, while I was at the bus stop of
Waltermart Paniqui located McArthur Highway, Brgy. Estacion, Paniqui
Tarlac, I lost my bag which contains the said passport:
3. That I could not locate the same and I discovered that it was lost/missing.
Then, I tried to look for it and other belongings but I did not find the same;
4. That I diligently exerted efforts to locate the said bag with the said passport,
but in spite of diligent search, it could not be found, hence, the same is
deemed lost and at a point beyond recovery;
5. That the said passport has not been encumbered, sold, pledged, assigned,
alienated, transferred, donated, or given as collateral for any debt or obligation
to or in favor of any person or entity;
6. That I understand that my declaration of the abovementioned passport as lost
shall be construed as satisfactory proof that the passport was lost, In
compliance with section 15 or RA 8239 or the Philippine Passport Act of 1996;
7. That I further understand that said passport will be immediately deemed
cancelled and may no longer be used for travel or other purposes. As such, in
case the said passport is found or retrieved, undersigned will immediately
surrender it to the DFA-Manila.
8. That I am executing is affidavit to attest to the veracity of the foregoing facts
and for whatever legal purpose it may serve under law.

IN WITNESS WHEREOF, I have hereunto set my hand this 19th day of September,
2019, in the Municipality of Paniqui, Province of Tarlac, Philippines.

JOY FIEBRA ENRIQUEZ

Affiant

SUBSCRIBED AND SWORN to before me this 19th day of September, 2019, in the
Municipality of Paniqui, Province of Tarlac, Philippines, Affiant exhibited to me her
Voter’s Identification Card-2501-0108A2186JFE20000.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2019.
REPUBLIC OF THE PHILIPPINES )
Municipality of Paniqui ) S.S
-------------------x

AFFIDAVIT OF LOSS

I, ROSEMARIE IMPAT INOCENCIO, of legal age, Filipino, married and a resident

of Oloybuaya, Gerona Tarlac, after having been duly sworn to in accordance with law,
hereby depos and state:

1. That I am the lawful holder of Philippine Passport issued by the Department

of Foreign Affairs-Angeles Pampanga;
2. That said passport was missing and must have been lost sometimes on April
2019, when there was a renovation/extension of our residential house at
Gerona, Tarlac;
3. That I diligently exerted efforts to locate the said passport, but in spite of
diligent search, it could not be found, hence, the same is deemed lost and at
a point beyond recovery;
4. That the said passport has not been encumbered, sold, pledged, assigned,
alienated, transferred, donated, or given as collateral for any debt or obligation
to or in favor of any person or entity;
5. That I understand that my declaration of the abovementioned passport as lost
shall be construed as satisfactory proof that the passport was lost, In
compliance with section 15 or RA 8239 or the Philippine Passport Act of 1996;
6. That I further understand that said passport will be immediately deemed
cancelled and may no longer be used for travel or other purposes. As such, in
case the said passport is found or retrieved, undersigned will immediately
surrender it to the DFA-Angeles Pampanga.
7. That I am executing is affidavit to attest to the veracity of the foregoing facts
and for whatever legal purpose it may serve under law.

IN WITNESS WHEREOF, I have hereunto set my hand this 22nd day of October
2019, in the Municipality of Paniqui, Province of Tarlac, Philippines.

ROSEMARIE IMPAT INOCENCIO

Affiant
Driver’s License No: C11-06-006376

SUBSCRIBED AND SWORN to before me this 22nd day of October 2019, in the
Municipality of Paniqui, Province of Tarlac.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2019.
REPUBLIC OF THE PHILIPPINES )
Municipality of Paniqui ) S.S
x-------------------x

AFFIDAVIT OF LOSS

I, ARWIN MAGLAYA MACARILAO, of legal age, Filipino, married and a resident

of Brgy. San Andres, Guimba Nueva Ecija, after having been duly sworn to in
accordance with law, hereby depos and state:

1. That I am the lawful holder of Philippine Passport issued by the Department

of Foreign Affairs-Manila;
2. That sometime on February 2002, we moved out from our previous house in
Muntinlupa City;
3. That the said passport was placed in a box with our other things which I
believed fell while being transferred by a truck to our new house at Guimba
Neuva Ecija;
4. That upon arrival on our new house, I immediately arranged our belongings
and I noticed that the said box was missing;

5. That I diligently exerted efforts to locate the said passport, but in spite of
diligent search, it could not be found, hence, the same is deemed lost and at
a point beyond recovery;
6. That the said passport has not been encumbered, sold, pledged, assigned,
alienated, transferred, donated, or given as collateral for any debt or obligation
to or in favor of any person or entity;
7. That I understand that my declaration of the abovementioned passport as lost
shall be construed as satisfactory proof that the passport was lost, In
compliance with section 15 or RA 8239 or the Philippine Passport Act of 1996;
8. That I further understand that said passport will be immediately deemed
cancelled and may no longer be used for travel or other purposes. As such, in
case the said passport is found or retrieved, undersigned will immediately
surrender it to the DFA-Manila.
9. That I am executing is affidavit to attest to the veracity of the foregoing facts
and for whatever legal purpose it may serve under law.

IN WITNESS WHEREOF, I have hereunto set my hand this 23rd day of October,
2019, in the Municipality of Paniqui, Province of Tarlac, Philippines.

ARWIN MAGLAYA MACARILAO

Affiant

SUBSCRIBED AND SWORN to before me this 23rd day of October 2019, in the
Municipality of Paniqui, Province of Tarlac, affiant exhibited to me his Driver’s License
with I.D. No. C05-16-013357.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2019.
REPUBLIC OF THE PHILIPPINES )
Municipality of Paniqui ) S.S
-------------------x

AFFIDAVIT OF LOSS

I, MIRACLE SILVA FLORES, of legal age, Filipino, married and a resident of

Sepung Calzada, Tarlac City, Tarlac after having been duly sworn to in accordance with
law, hereby depos and state:

1. That I am the lawful holder of Philippine Passport bearing No.__________ issued

by the Department of Foreign Affairs-Pampanga;
2. That sometime on October, 2019 said passport was lost inside my bag, I could
not locate the same and I discovered that it was lost/missing. Then, I tried to look
for it and other belongings but I did not find the same;
3. That I diligently exerted efforts to locate the said passport, but in spite of diligent
search, it could not be found, hence, the same is deemed lost and at a point
beyond recovery;
4. That the said passport has not been encumbered, sold, pledged, assigned,
alienated, transferred, donated, or given as collateral for any debt or obligation
to or in favor of any person or entity;
5. That I understand that my declaration of the abovementioned passport as lost
shall be construed as satisfactory proof that the passport was lost, In compliance
with section 15 or RA 8239 or the Philippine Passport Act of 1996;
6. That I further understand that said passport will be immediately deemed
cancelled and may no longer be used for travel or other purposes. As such, in
case the said passport is found or retrieved, undersigned will immediately
surrender it to the DFA-Pampanga.
7. That I am executing is affidavit to attest to the veracity of the foregoing facts and
for whatever legal purpose it may serve under law.

IN WITNESS WHEREOF, I have hereunto set my hand this 05th day of November
2019, in the City/Municipality of Paniqui, Province of Tarlac, Philippines.

MIRACLE SILVA FLORES

Affiant

SUBSCRIBED AND SWORN to before me this 05 th day of November, 2019, in the

City/Municipality of Paniqui, Province of Tarlac, Philippines, Affiant exhibited to me her
PhilHealth Card No. 02-026209805-3.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2019.
REPUBLIC OF THE PHILIPPINES )
Municipality of Paniqui ) S.S
-------------------x

AFFIDAVIT OF LOSS

I, ERICZON LAXAMANA, of legal age, Filipino, single and a resident of Poblacion

Norte, Paniqui, Tarlac, after having been duly sworn to in accordance with law, hereby
depos and state:

1. That I am the lawful holder of Philippine Passport issued by the Department

of Foreign Affairs-Calasiao, Pangasinan;
2. That I usually kept the said passport inside my sling bag;
3. That sometime on October 3, 2019, I dropped/lost the above said passport
while riding in a bus, from Tarlac City going to our home;
4. That I diligently exerted efforts to locate the said passport, but in spite of
diligent search, it could not be found, hence, the same is deemed lost and at
a point beyond recovery;
5. That the said passport has not been encumbered, sold, pledged, assigned,
alienated, transferred, donated, or given as collateral for any debt or obligation
to or in favor of any person or entity;
6. That I understand that my declaration of the abovementioned passport as lost
shall be construed as satisfactory proof that the passport was lost, In
compliance with section 15 or RA 8239 or the Philippine Passport Act of 1996;
7. That I further understand that said passport will be immediately deemed
cancelled and may no longer be used for travel or other purposes. As such, in
case the said passport is found or retrieved, undersigned will immediately
surrender it to the DFA-Manila.
8. That I am executing is affidavit to attest to the veracity of the foregoing facts
and for whatever legal purpose it may serve under law.

IN WITNESS WHEREOF, I have hereunto set my hand this 23rd day of

September, 2019, in the Municipality of Paniqui, Province of Tarlac, Philippines.

RAMON JOSEPH SANTIAGO CASTILLO

Affiant

SUBSCRIBED AND SWORN to before me this 23rd day of September 2019, in the
Municipality of Paniqui, Province of Tarlac.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2019.
REPUBLIC OF THE PHILIPPINES )
Municipality of Paniqui ) S.S
-------------------x

AFFIDAVIT OF LOSS

I, LARRY JAMES BERMEJO JANAYON, of legal age, Filipino, married and a

resident of Blk. 3, Lot 24, North Hills Subd., City of S.J.D.M. Bulacan, after having been
duly sworn to in accordance with law, hereby depos and state:

1. That I am the lawful holder of Philippine Passport bearing passport number

EB7283789 issued on February 04, 2013, by the Department of Foreign
Affairs (DFA)-NCR WEST;
2. That I usually kept the said passport inside my sling bag;
3. That sometime on May 2019, I dropped/lost the above said passport while
riding in a bus, from Metro Manila going to our home;
4. That I diligently exerted efforts to locate the said passport, but in spite of
diligent search, it could not be found, hence, the same is deemed lost and at
a point beyond recovery;
5. That the said passport has not been encu mbered, sold, pledged, assigned,
alienated, transferred, donated, or given as collateral for any debt or obligation
to or in favor of any person or entity;
6. That I understand that my declaration of the abovementioned passport as lost
shall be construed as satisfactory proof that the passport was lost, In
compliance with section 15 or RA 8239 or the Philippine Passport Act of 1996;
7. That I further understand that said passport will be immediately deemed
cancelled and may no longer be used for travel or other purposes. As such, in
case the said passport is found or retrieved, undersigned will immediately
surrender it to the DFA;
8. That I am executing is affidavit to attest to the veracity of the foregoing facts
and for whatever legal purpose it may serve under law.

IN WITNESS WHEREOF, I have hereunto set my hand this 25th day of November,
2019, in the Municipality of Paniqui, Province of Tarlac, Philippines.

LARRY JAMES BERMEJO JANAYON

Affiant

SUBSCRIBED AND SWORN to before me this 25th day of November 2019, in the
Municipality of Paniqui, Province of Tarlac affiant exhibited to me his driver’s License
with number N04-13-027046.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2019.
REPUBLIC OF THE PHILIPPINES )
Municipality of Paniqui ) S.S
-------------------x

AFFIDAVIT OF LOSS

I, DAISY ALIPIO AGPAOA, of legal age, Filipino, single and with address at Sta.
Lucia East, Moncada Tarlac after having been duly sworn to in accordance with law,
hereby depos and state:

1. That I am the lawful holder of Philippine Passport issued by the Department

of Foreign Affairs-Manila;
2. That I usually kept the said passport inside my bag;
3. That sometime on year 2010, I dropped/lost the above said passport while
riding in a train, from Aichiken Shi Ichinomiya Shi (Japan) going to our home
at Ichinomiya Shi, Ki Sogawa Cho Kuroda Yama 4-1 Tourney Kisogawa 608
(Japan);
4. That I diligently exerted efforts to locate the said passport, but in spite of
diligent search, it could not be found, hence, the same is deemed lost and at
a point beyond recovery;
5. That the said passport has not been encumbered, sold, pledged, assigned,
alienated, transferred, donated, or given as collateral for any debt or obligation
to or in favor of any person or entity;
6. That I understand that my declaration of the abovementioned passport as lost
shall be construed as satisfactory proof that the passport was lost, In
compliance with section 15 or RA 8239 or the Philippine Passport Act of 1996;
7. That I further understand that said passport will be immediately deemed
cancelled and may no longer be used for travel or other purposes. As such, in
case the said passport is found or retrieved, undersigned will immediately
surrender it to the DFA-Manila.
8. That I am executing is affidavit to attest to the veracity of the foregoing facts
and for whatever legal purpose it may serve under law.

IN WITNESS WHEREOF, I have hereunto set my hand this 2nd day of December,
2019, in the Municipality of Paniqui, Province of Tarlac, Philippines.

DAISY ALIPIO AGPAOA

Affiant

SUBSCRIBED AND SWORN to before me this 2nd day of December 2019, in the
Municipality of Paniqui, Province of Tarlac.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2019.