REPUBLIC OF THE PHILIPPINES )

CITY OF LAPU-LAPU ) S.S.

AFFIDAVIT OF LOSS

I, Sarah Q. Ong, of legal age, Filipino, married, resident of Ibapo, Mactan,

Lapu-lapu City, after having been sworn to in accordance with law, do hereby
depose and say:

1. That I am the owner of the Official receipt with OR NO. 0067-2017-

03685 issued by M. Lhuillier Pawnshop located at Lapu-Lapu City Public
Market evidencing the receipt of the foregoing of my pawned jewelry.

2. That on December 21, 2017, I found the aforesaid receipt at the floor
while I was doing my household chores, and throw it in the garbage
can, believing that it is just one of the unnecessary receipts to be
dumped.

3. When I am about to redeem my pawned jewelry, I realized that I have

thrown my Official Receipt, and I exerted my best effort to recover the
said receipt but unfortunately I lost the foregoing.

4. That I am executing this affidavit in order to attest the fact that my

Official Receipt was lost and now beyond recovery.

In witness whereof, I have hereunto affixed my signature on this 10th day

of February 2018, at Lapu-Lapu City.

Sarah Q. Ong
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this 10th day of February 2018,

at Lapu-Lapu City, affiant exhibiting to me her competent identification card
Police Clearance card with ID NO. LLC1391843, issued at Lapu-Lapu City.

Doc No.____
Page No.____
Book No.____
Series of 2018.