Foreign Service of the Philippines
)
EMBASSY OF THE REPUBLIC OF THE PHILIPPINES) S.S.
)
Berlin, Germany
AFFIDAVIT OF LOSS
I, __________________________________________________________________,
Filipino, of legal age, single/married to ___________________________________________,
and resident of _______________________________________________________________
__________________________________________________________________________ ,
after being sworn according to law, hereby depose and say:
That I was born on _____________________ at (city/province/country) ___________
__________________________________________________________ of Filipino parent(s).
My father is (name of father) ___________________________________________________,
native of (province/city) _______________________________________________________,
and my mother is (name of mother) _________________________________________,
native of (province/city) _______________________________________________________;
That I applied for and was issued Philippine passport no. _______________________
at ______________________________, on or about _______________________________ ;
That this passport is no longer in my possession due to the following circumstances:
(Give detailed account)
_____________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
That I am executing this affidavit in connection with my application for a new
Philippine passport in lieu of my lost passport.
FURTHER AFFIANT SAYETH NAUGHT.
IN
WITNESS
WHEREOF,
I
have
hereunto
set
my
hand
this
____
day
of
______________ 201_ at _____________, Germany.
_________________________
AFFIANT
SUBSCRIBED AND SWORN TO before me this ___ day of ___________________ 201_ at
___________ , Germany.
_________________________
Administering Officer