(Affidavit of Loss Pawnshop Ticket)

Republic of the Philippines)

Province of Bulacan)S.S.

City/Municipality of Malolos)

AFFIDAVIT OF LOSS

I, Arlene R. De Guzman, Filipino, of legal age, married, and a resident of Blk

23 Lot 8, Phase 5c,Grand Royale Subdivision, Malolos City, Bulacan,

Philippines, after being duly sworn in accordance with law, depose and state:

1. That sometime on July 13, 2017, I pawned my 18k ID Bracelet with

Cebuana Lhuillier located at Malolos Crossing, Bulacan and for which I

was issued Pawn Ticket 20111sg045212.

2. That sometime on October 11, 2017, my wallet that contains the said

Pawn Ticket was misplaced and got lost.

3. 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 _____________

at _____________, Philippines.

Affiant

Arlene R. De Guzman