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    Affidavit of Loss of Passport

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    Brgy Sta Cruz Lgu

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    © All Rights Reserved
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    Affidavit of Loss of Passport

    Uploaded by

    Brgy Sta Cruz Lgu
    11 views2 pages

    Original Title

    AFFIDAVIT OF LOSS OF PASSPORT

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    11 views2 pages

    Affidavit of Loss of Passport

    Uploaded by

    Brgy Sta Cruz Lgu

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
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    AFFIDAVIT OF LOSS OF PASSPORT

    I, ____________________________________________, Filipino citizen, of legal


    age,single/married /widow(er)/ divorced / annulled, and presently residing at
    _________________________________________________________________ after
    having been duly sworn to in accordance with law, hereby depose and state:

    1. That the undersigned was issued a Philippine Passport by the Department of


    Foreign Affairs (DFA) in Manila with the following details:

    Philippine Passport No: _____________________,


    Date of Issue: ___________________,
    Issuing Authority: ______________________

    2. That the said passport was lost on ______________________ (Date) under the
    following circumstances:
    ___________________________________________________________________
    ___________________________________________________________________
    ___________________________________________________________________
    ___________________________________________________________________
    ___________________________________________________________________
    ___________________________________________________________________

    3. That the undersigned exerted all efforts possible to locate the said passport
    but to no avail;

    4. That the undersigned fully understands that the said passport is automatically
    deemed cancelled upon declaration of loss and that if found, it can no longer
    be used;

    5. That the undersigned is executing this Affidavit of Loss in connection with


    his/her present application for a new Philippine passport; and That further
    Affiant/s sayeth none.

    IN WITNESS WHEREOF, I have hereunto affixed my signature this ____ day of


    ___________________ 20____ at _____________________________.

    _________________________________
    AFFIANT’S SIGNATURE OVER PRINTED NAME

    SUBSCRIBED AND SWORN TO before me this ____ day of _________________ 20___


    at _______________________________.

    _________________________________
    NOTARY PUBLIC
    REPUBLIC OF THE PHILIPPINES)
    PROVINCE OF NEGROS OCCIDENTAL)
    CITY/MUN. ________________) S.S.
    x------------------------------------------------x

    AFFIDAVIT OF LOSS
    I, ARLEEN MARIE A. BAYONA, of legal age, Filipino, single and a resident
    of Purok Minoro, Brgy. Sta. Cruz, Murcia, Neg. Occ., after having been duly
    sworn to in accordance with law, depose and state:

    1. That I am a holder of Automated Teller Machine (ATM) Card No.


    _____________ with Account No. 000820497568 duly issued in my
    favor by Banco de Oro Unibank, Inc. (Bacolod-Araneta Branch) on May 5,
    2017 in Bacolod City;

    2. That I used to put said ATM card in my extra wallet inside my bag;

    3. That sometime on September 2, 2023, when I arrived home from work, I


    discovered that the said extra wallet was lost;

    4. That diligent effort to locate the same proved futile;

    5. That in view thereof, I now desire and hereby request BDO Bacolod-
    Araneta Branch to issue another ATM card in lieu of the lost one;

    6. That I bind myself to save BDO harmless from any loss or damage that it
    may incur in connection with the issuance of a new ATM card in lieu of
    the lost one;

    7. That I am executing this affidavit to attest to the foregoing facts and for
    any legal purpose it may serve.

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


    ______________ in Bacolod City, Negros Occidental.

    ARLEEN MARIE A. BAYONA


    Affiant
    TIN: 433-666-986

    SUBCRIBED AND SWORN TO before me this ______ day of _____________ in


    __________________________, affiant exhibiting to me his/her valid proof of identification.

    ________________________
    Notary Public

    Doc. No. _____;


    Page No. _____;
    Book No. _____;
    Series of ____.

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