Republic of the Philippines )

Baguio City ) s.s

AFFIDAVIT OF LOSS
I, RAIMA HOPE B. APLOD, of legal age, single, Filipino Citizen and
presently residing at #054 Prk. 9, Irisan, Baguio City, Philippines after having
been duly sworn to in accordance with law do hereby depose and say that:

1. I am a holder of a PHILIPPINE PASSPORT issued by the Department of

Foreign Affairs (DFA) Baguio City Office;

2. In lost my passport on January 27, 2018. I rode a TAXI from Rizal Park
going home to Irisan, Baguio City. I alighted from the said taxi and when
I was already in our house and I noticed that the pouch containing my
passport was no longer in my bag;

3. I exerted diligent effort to locate my PHILIPPINE PASSPORT but the

same never found, hence, considered forever lost;

4. Said PHILIPPINE PASSPORT was never given nor pledged to anyone for
any purpose whatsoever, nor was it taken or confiscated by the
authorities for any violation of the passport law;

5. I am executing this affidavit to attest to the veracity and truthfulness of

my foregoing statements and for the purpose of securing a new
PHILIPPINE PASSPORT in lieu of the lost one and for other lawful
intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 2nd day of

February, 2018 at Baguio City, Philippines.

RAIMA HOPE B. APLOD

AFFIANT
UMID ID CRN: 0111-7902143-0

SUBSCRIBED AND SWORN TO before me this 2nd day of February, 2018

at Baguio City, Philippines. Affiant personally appeared before me and to be the
same person who executed this instrument as her free act and deed.

MODESTO T. ANDONG
Notary Public
Comm. No. 39-NC-18-R/Until: December 31, 2019
PTR No. 3397734/12-13-2017/BC (for 2018)
IBP No. 1083758/12-13-2017 (for 2018)
Baguio-Benguet Chapter
Roll No. 31289/5-15-81/Manila
Doc. No. 194; MCLE COMPLIANCE No. VI-0000192/June 14, 2016
Page No. 40; BIR TIN No. 121-017-652
Book No. XXVIII; No. 19, 2nd Floor Old Market Bldg.,
Series of 2018. Magsaysay Ave., Baguio City, Philippines