Republic of the Philippines)

Baguio City……………………) S.S.

AFFIDAVIT OF LOSS
I, BRIGITTE S. COLIADO, of legal age, single, Filipino Citizen and presently residing
at Camp 1, Klondykes, Tuba, Benguet, 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), San Fernando City Office;

2. Sometime in 2014 I tried my luck and applied for work abroad, however, I was not
lucky. An agency lends its help in processing my application and among the
documents I submitted is my aforesaid passport. However, my application did not
push through. It was late for me to learn that the agency is fake, worst they did not
return my documents and my passport;

3. I exerted diligent effort to locate or contact the said agency to retrieve my

PHILIPPINE PASSPORT but they could not be found anymore, hence, said passport
is 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 law particularly 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 24th day of April, 2018 at
Baguio City, Philippines.

BRIGITTE S. COLIADO
Affiant
POSTAL ID No. B29180090939 P
Valid Until: February 6, 2021

SUBSCRIBED AND SWORN TO before me this 24th day of April, 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. 235; MCLE COMPLIANCE No. VI-0000192/June 14, 2016
Page No. 48; BIR TIN No. 121-017-652
Book No. XXIX; No. 19, 2nd Floor Old Market Bldg.,
Series of 2018. Magsaysay Ave., Baguio City, Philippines

Affidavit Loss
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