REPUBLIC OF THE PHILIPPINES)

PROVINCE OF QUIRINO )
MUNICIPALITY OF DIFFUN ) S.S.
x-----------------------x

AFFIDAVIT OF LOSS PAWN TICKET

I, GEORGE P. RADAM, of legal age, married, Filipino and a resident of Andres
Bonifacio, Diffun, Quirino, after being duly sworn in accordance with law, depose and state:

1. That I pawned a CREOLA EARING, 21K, 4.6 GMS in the amount of P9,752
before Cebuana Lhuillier, Diffun, Quirino;

2. That I was issued a PAWN TICKET 20306 SG 018589 BY SAID

pawnshop;

3. That the date of loan was on December 21, 2018 and expires on April 22,
2019

4. That sometime on January, 2019 when, I was about to renew my loan, I

noticed that the pawn ticket was missing;

5. That I realized that said pawn ticket can no longer be located;

6. That I exerted efforts to locate the same, but to no avail;

6. As such, I am executing this Affidavit to attest to the truth of the foregoing

and for whatever legal purposes that this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 20th day of March 2019
at Diffun, Quirino, Philippines.

GEORGE P. RADAM
Affiant
TIN No. 288-054-520-000

SUBSCRIBED AND SWORN TO before me this 20th day of March 2019 in the
Municipality of Diffun, Province of Quirino, Philippines and I further certify that I have
personally examined the affiant and I convinced and satisfied that he voluntarily executed the
foregoing Affidavit of Loss and understood all the contents hereof and that they are true and
correct as to her own personal knowledge.