Republic of the Philippines) Province of Quezon)S.S. City/Municipality of Mauban) x---------------x AFFIDAVIT OF LOSS I, Jim A.

Pelejo, Filipino, of legal age, single, and a resident of Brgy. San Lorenzo, Mauban, Quezon, Philippines, after being duly sworn in accordance with law, depose and state: That sometime on June 2013, I pawned my sisters earrings (1gpofe 1.2 g.) with Racquel Pawnshop located at Mauban, Quezon and for which I was issued Pawn Ticket with number 046011. That sometime on August 2013, my wallet that contains the said Pawn Ticket was misplaced and got lost. That despite diligent search and efforts to locate the said wallet and pawn ticket, I could not find the same such that I now believe that they are now lost beyond recovery. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing facts. IN WITNESS WHEREOF, I have hereunto set my hand this 5th day of September, 2013 at Mauban, Quezon, Philippines.

JIM A. PELEJO Affiant SUBSCRIBED AND SWORN to before me this 5th day of September, 2013 in Mauban, Quezon, Philippines, affiant having exhibited to me his community tax certificate with no. ___________ issued on ______________ at Mauban, Quezon. Doc. No.________; Page No.________; Book No.________;