REPUBLIC OF THE PHILIPPINES)

 CITY OF BAGUIO                                 ) S.S

AFFIDAVIT OF MUTILATION

 I, ANDRES BONIFACIO, of legal age, married, Filipino Citizen, and with postal and residence address at No. 47 Lower Quirino Hill Barangay, Baguio City, after having been duly sworn to in accordance with law hereby depose and say:

1.       That I am the holder of the Passport numbered 1234, issued by the Department of Foreign Affairs on February 28,2008 at San Fernando la union;

2.  That on October 27, 2009, my bag, containing my passport was snatched. After two (2) days, my bag, together with my passport was recovered by the police officers, however, the portion of my passport bearing my photograph was torn and could no longer be located;

3. That I reported the above-mentioned incident to the police and a certified true copy of the police blotter is hereto attached;

4. That I am executing this affidavit to attest to  the  truth of  the   foregoing  and for the purpose of applying for the  replacement of said lost  passport.

IN WITNESS WHEREOF, I hereunto set my hand this 5^th day of November 2011 at Baguio City, Philippines.

                                                                                             ANDRES BONIFACIO

                                                                                                        (Affiant)

SUBSCRIBED AND SWORN to before me, a notary public in and for the City of Baguio this 5^{th day} of November, 2011, at Baguio City, Philippines, affiant appearing before me with his CTC No.1234, issued on January 5, 2011, at Baguio City, and who identified herself with his SSS ID No.1234, and who signed the foregoing document in my presence and sworn as to said document that he understood the contents thereof and that the same was his free and voluntary act and deed.

Doc. No.  4                                                                   RYAN G. MALUBAY

Page No.  1                                                                        Notary Public

Book No.   1                                                                 Until December 31, 2011

Series of 2011                                                  IBP No. 0301099; 07-06-10; Manila

                                               PTR No. 825030; 04-26-10; Baguio City

                                             Roll No. 57765

                                                                 MCLE Governing Board Order No. 1 Series of 2008, dated July 4, 2008