Lost Explaination
Because I am careless custody, I lost my old passport (The passport ).
The passport has bore entry and exit stamps to denied records.
(and it has denied records: , ).
Declarant：
Date:
致日本駐上海總領事館：
本人 由於個人原因不慎將老護照第遺失，舊護照上無任何拒籤記錄。
特此證明
簽名:
日期:
號
