1

Embassy of the Republic of the Philippines)

City of Tokyo, Japan
) SS.

AFFIDAVIT OF LOSS
I, Gina Sanoria Maita, of Legal Age, Filipino, Single and resident of
Aomori Ken Hachinohe Shi Uruichi 1-2-3 Etoworld Hachinohe Daiichi
120, hereby depose and states that:
1. That on February 18, 2004, I was issued a Philippine Passport by
the Department of Foreign Affairs in Manila, with Passport No.
XX3040590. Attached hereto Annex A is a copy of my Alien
Card embodying the details of the said Passport.

2. That recently I had tried to look for the said passport but the
same could not be found;

3. That despite diligent search and efforts to locate the said

passport, I could not find the same such that I now believe that it
is now lost beyond recovery;

4. As such, I am executing this Affidavit of Loss to attest to the

truth of the foregoing

IN WITNESS WHEREOF, I have hereunto set my hand this 19 th

day of February 2016 at ___________.
Gina Sanoria Maita
Affiant
SUBSCRIBED AND SWORN to before me this 19th day of
February 2016, at the _________ affiant exhibiting to me his Competent
Evidence of Identity no. ____________________ issued on ________________
at ______________.
Doc. No. ____;
Page No. ____;
Book No. ____;
Series of 2016.