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REPUBLIC OF THE PHILIPPINES) IN THE_______________________ )S.c. X- - - - - - - - - - - - - - - - - - - - - - - - X AFFIDAVIT OF RETRIEVAL OF LOSS PASSPORT
I, __________________________________________, of legal age, Filipino, single and a resident of ______________________________________________, after having been duly sworn to law, depose and state: 1. That I am the same and identical person named above who is the registered owner of Passport No. ___________________,issued by ________________________, valid _________________________________; _________________________ ________; 2. That said Passport was retrieved yesterday through the help ,kindness and assistance of close relatives and friend; 3. That I am executing this Affidavit to attest the truth of the foregoing statements and to request CANCELLATION of my newly applied Passport at DFA, Davao City under Official Official Receipt No. __________________, dated ______________, 2010; IN WITNESS WHEREOF, I have hereunto set my hand this ______ day of __________, 2010, at , Cotabato City, Philippines. ____________________ Affiant SIGNED IN THE PRESENCE OF: 1.
_________________________
2. _______________________
SUBSCRIBED AND SWORN to before me this ____ day of ________ 2010, at Cotabato City, Philippines. Doc. No. Page No. Book No. Series of
