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:
致日本驻上海总领事馆：
本人 由于个人原因不慎将老护照第遗失，旧护照上无任何拒签记录。
特此证明
签名:
日期:
号