AFFIDAVIT RE DAMAGED PASSPORTaffidavit facts damaged …

EMBASSY OF THE REPUBLIC OF THE PHILIPPINES)

Consular Section

) S.S.

Amman, Hashemite Kingdom of Jordan

)

AFFIDAVIT RE DAMAGED PASSPORT

I,

, Filipino, of legal age,

, presently

residing at

, and with permanent

address in the Philippines at

,

after having been sworn in according to law, do hereby depose and state that:

1. I was issued on

by the

,

in

, a Philippine passport with serial number

;

2. The said passport was damaged on or about following circumstances:

, because of the

3. The damage to the passport issued in my name was inadvertent and unintentional;

4. I am executing this affidavit to declare the factual circumstances as to how said passport was damaged beyond further use and to support my present application for a new passport to replace the one that was damaged; and that

5. Each and all of the facts stated here are true and correct, and made with full awareness that I may be held liable for perjury and have the passport issued in my name cancelled if any misrepresentations or falsehoods are found to have been made in this affidavit.

Further Affiant sayeth naught.

IN WITNESS WHEREOF, I hereby affix my signature to this affidavit, here at Consular

Section of the Embassy of the Philippines in Amman, Hashemite Kingdom of Jordan

on

.

Affiant

SUBSCRIBED AND SWORN TO before me here at the Consular Section of the Embassy

of the Philippines in Amman, Hashemite Kingdom of Jordan, on

.

Doc. No: Page No: Book No: Series of Fee Paid: O.R. No: Svc. No:

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