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REPUBLIC OF THE PHILIPPINES)
CITY OF MAKATI ) S.S.x----------------------------------x
AFFIDAVIT OF LOSS
I, Muchacho Achong,of legal age, Filipino, single and a resident of MetroManila, after having been duly sworn to in accordance with law, depose and
state THAT:
1. On January 31, 2009, I was issued a Philippine Passport by the Department
of Affairs in Manila;
2. Recently, I had tried to look for the said passport but the same could not befound;
3. Despite diligent search and efforts to locate the said passport which contains
my Visa and has a 10 years of validity, I could not find the same such that Ibelieve that it is now lost beyond recovery;
4. As such, I am executing this affidavit to attest to the foregoing facts and tosupport the application for the issuance of a new one in lieu of the one which
was lost.
IN WITNESS WHEREOF, I have hereunto set my hand this July03,2009 in Makati City, Metro Manila, Philippines.
____________________Affiant
GSIS ID No. _____________
SUBCRIBED AND SWORN TO before me
this___________________in _________________, Philippines, affiantexhibiting to me his valid proof of identification.
Doc. No. _____;Page No. _____;Book No. _____;Series of 2013.
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REPUBLIC OF THE PHILIPPINES)
CITY OF MAKATI ) S.S.x----------------------------------x
AFFIDAVIT OF LOSS
I, Estrelita Licuanan, of legal age, Filipino, single and a resident of #33
San Lopez, Aurora Hill, Baguio City, after having been duly sworn to in
accordance with law, depose and state THAT:
1. On , 2010, I was issued a Philippine Passport by the Department of Affairs inManila;
2. Recently, I had tried to look for the said passport but the same could not be
found;
3. Despite diligent search and efforts to locate the said passport, I could not
find the same such that I believe that it is now lost beyond recovery;
4. As such, I am executing this affidavit to attest to the foregoing facts and to
support the application for the issuance of a new one in lieu of the one whichwas lost.
IN WITNESS WHEREOF, I have hereunto set my hand
this___________________in Makati City, Metro Manila, Philippines.
____________________Affiant
GSIS ID No. _____________
SUBCRIBED AND SWORN TO before me
this___________________in _________________, Philippines, affiantexhibiting to me his valid proof of identification.
Doc. No. _____;Page No. _____;Book No. _____;Series of 2013.
AFFIDAVIT OF LOSS OF IDENTIFICATION CARD
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REPUBLIC OF THE PHILIPPINES )
_____________________________ ) SS.
I, Dionisia Campuhan, Filipino, of legal age, single/married to Manny Pacquito, and a resident of
#33 San Lopez, Aurora Hill, Baguio City, after having been duly sworn in accordance with law,
hereby depose and say:
1. That I am a holder of a school/company identification card bearing serial number 22340 issued
by Office of the Senior Citizen Affairs
2. That I used to put said identification card in my bag, among others;
3. That sometime on September 21, 1994 when I arrived home from medication, I discovered
that my senior citizen ID card was no longer in my pouch where I used to place it;
4. That diligent effort to locate the same had proved useless; Despite diligent search and efforts
5. That I am executing this affidavit to attest to the truth of the foregoing facts and to request for
a replacement of said senior citizen ID card
IN WITNESS WHEREOF, I have hereunto affixed my signature this 01 day of October 1994
at Metro Manila, Philippines.
_________________________________
( Signature of Affiant over Printed Name)
SUBSCRIBED AND SWORN TO before me, a notary public in and for_____________________ this ____ day of ____________ 20___. The affiant, whom I identified
through the following competent evidence of identity: (ID type and number), valid from (date)
to (date) issued by (issuing authority), personally signed the foregoing instrument before me
and avowed under penalty of law to the whole truth of the contents of said instrument.
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Affidavit of Desistance Rape Case
Republic of the Philippines)Province of_______________)S.S.
City/Municipality of____________)
x - - - - - - - - - x
AFFIDAVIT OF DESISTANCE
I,____________,Filipino, single, with residence__________, under oath allege:
1.That I am the complainant in Criminal Case No.__________for alleged "RAPE" against
accused___________, which case is pending before the Regional Trial Court, Branch______,
_____________City, Philippines;
2.That I signed the aforesaid complaint against accused__________against my will, my
signature in the complaint having been obtained thru force, violence and intimidation done to meby my parents;
3.There is no truth to the allegations contained in my sworn statement executed by me againstmy will on___________at____________, taken by____________. There was no force, violence
or intimidation done against me by said accused___________. I was not forced by him to submit
to his desires. It was all in accordance with my own will, volition and consent that I wentpersonally to him because we love each other and I agree and consent to live with him as my
husband;
4.I therefore respectfully request that the above-mentioned case filed against said___________be
dismissed as in fact I now withdraw my complaint against him and I further manifest under oaththat I am now desisting from testifying against him in Court or in any other government entity or
agency in connection with the said criminal case.
IN WITNESS WHEREOF, I have hereunto set my hand this___________at____________,
Philippines.
AFFIANT
(JURAT)
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