Affidavit of Loss of Passport and Seaman's Book

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AFFIDAVIT OF LOSS OF PASSPORT AND SEAMAN’S BOOK

I, _ARES LITO PAQUINGAN , Filipino citizen, of legal age, single / married / widow(er) /
divorced / annulled, and presently residing at BLOCK 3 LOT 10 PHASE 3 FERN ST., VALLE
VERDE, LANGKAAN 2, DASMARIÑAS, CAVITE after having been duly sworn to in accordance
with law, hereby depose and state:

1. That the undersigned was issued a Philippine Passport by the Department of Foreign Affairs
(DFA) in Cagayan De Oro with the following details: Philippine Passport No:EB3153835, Date of
Issue: 25-JULY-2011, and Issuing Authority: DFA CAGAYAN DE ORO.

2. That I am the holder/owner/possessor of Seafarers Identification and Record Book or


Seaman’s Book

3. That the said passport and seaman’s book was already lost since the year 2020’s

4. That the undersigned exerted all efforts possible to locate the said passport and seaman’s
book but to no avail;

5. That the undersigned fully understands that the said passport and seaman’s book are
automatically deemed canceled upon declaration of loss and that if found, it can no longer be
used;

6. That the undersigned is executing this Affidavit of Loss in connection with his/her present
application for a requirements for BS Endorsement ; and

That further Affiant/s sayeth none.

IN WITNESS WHEREOF, I have hereunto affix my signature this day of at


_____________________________ .

AFFIANT’S SIGNATURE OVER PRINTED NAME

SUBSCRIBED AND SWORN TO before me this ____ day of _________________ 20___ at


_______________________________. _________________________________

ADMINISTERING OFFICER / NOTARY PUBLIC

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