AFFIDAVIT OF MUTILATION

Republic of the Philippines)

Province of Cavite) S.S.)
City of Tagaytay
x---------x

I, FRANCINE DIANNE LUNA PASAMBA, of legal age, Filipino, single

and with present residence and postal address at Purok 73, Kaybagal North,
Tagaytay City,Cavite after being duly sworn to in accordance with law,
hereby depose and state:

That I am a holder of a Philippine passport issued by the Department of

Foreign Affairs with Passport Number EC5065340 and expiring on 18 August
2020;

That two days ago, I was in Tagaytay City when a sudden and unexpected
rain occurred to which my bag and all my valuables inside got wet;

That despite diligent efforts to restore it, I could not possibly do it such that
I honestly believe that it now needs a replacement as the picture is no
longer visible;

That I am executing this affidavit in good faith and without any intention to
defraud or deceive;

As such, I am executing this Affidavit of Mutilation to attest to the truth of

the foregoing specifically for the replacement of the PASSPORT and for other
reliefs as may be just and equitable;

IN WITNESS WHEREOF, I have hereunto set my hand this August

02, 2018 at Tagaytay City, Cavite, Philippines.

FRANCINE DIANNE L. PASAMBA

AFFIANT
ID PRESENTED: BIR TIN ID 413-647-305-000

SUBSCRIBED AND SWORN TO BEFORE ME, a Notary Public for and

in the Province of Cavite this _______________. Affiant personally came
who is known to me as the same person who signed the foregoing
instrument before me and avowed under penalty of law to the whole truth of
the contents of said instrument.

Doc. No.______
Page No. ______
Book No. _____
Series of 2018