Republic of the Philippinesl

Santa Cruz, Laguna

] s.s.

AFFIDAVIT OF LOSS
I, MARIA FE ESCODERO ESCANO, of legal age, Filipino, single and

resident of Brgy. Palasan, Santa Cruz, Laguna, after having been

sworn in accordance with law, hereby depose and state that -

L. I previously had a Philippine Passport and an Social Security

Systerm (SSS) I.D. Card.

2.

Unfo rtunately, many years ago, the said passport and SSS card

were lost during a robbery committed by unknown person/s in

the house of a relative in Dasmarifias, Cavite where I used to stay.

3.

Inspite of diligent efforts in trying to locate my passport and SSS

card, I can no longer find said items. Hence, for all intents and
purposes, the said passport and SSS card are now deemed lost
and heyond recovery.

4. I exe'cuted this affidavit

to attest to the truth of the foregoing

declerrations and to serve as supporting documentary proof in
secur:ing a new passport and a new SSS I.D. Card.

IN WITNESS WHEREFORE, I hereto affixed

May 2O1+ in Santa Crrtz, Laguna.

ys

ture this 05

ESGAilO

nt
SUBS,CRIBED AND SWORN to before m
affiant w;ith Postal I.D. No. 134521A issuecl at

this 05 May 2A14 by

nta Cruz, Laguna Post

Office on 20 April 2012.

J0 ,
e"5r No.-E
Doc. No.

PaoeNo. 1
Series

ol26t4

NOTARY
NOTARY

COMM.

31 DECEMBER 2014

FOR TH

coMMrssloN IN sP

OF LAGUNA
PROC. NO. 129(13)

IBP O.R. No. 941754, O3 January 2014, Lagilna Chapter

PTR O.R. No. 16531O9, O3 January 2014, Laguna
Rofl No. 42246, admitted to practice law on 9 May 1997
MCLE Compliance No.IV-O021894 dated 4 Sept. 2013