Calacsan, Leamer (affidavit Of Loss).docx

Republic of the Philippines) City of Dagupan

) s.s.

x-------------------------------x AFFIDAVIT OF LOSS I, LEAMER CALACSAN y Estrada, of legal age, Filipino citizen, married, and a resident of Sitio Calay, Barangay Tuliao, Sta. Barbara, Pangasinan, after being duly sworn in accordance with law, depose and state that: 1. I was issued on 19 June 2018 by the Department of Foreign Affairs (DFA) National Capital Region North, a Philippine Passport with serial number P7577263A.; 2. The said passport was destroyed on or about 29 October 2018 due to the flood caused by Typhoon Rosita; 3. The damage to the passport issued in my name was inadvertent and unintentional; and 4. I am executing this Affidavit to declare the factual circumstances as to how said passport was damaged beyond further use and to support my present application for a new passport to replace the one that was damaged. Further Affiant sayeth naught. IN WITNESS WHEREOF, I have hereunto set my hand this 22nd day of November 2018 in the City of Dagupan, Philippines.

LEAMER E. CALACSAN Affiant ___________________ ___________________ SUBSCRIBED AND SWORN to before me this 22nd day of November 2018 in the City of Dagupan, Philippines.

Administering Officer