Republic of the Philippines)

Province of Cebu )S.S.
Mandaue City )
x---------------x

AFFIDAVIT OF LOSS

I, EDWILYN PASAOL, Filipino, of legal age, married and a resident of Gairan,

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

1. That I pawned my jewelry at Cebuana Pawnshop, Bogo City, Cebu, Philippines

and was issued a Pawn Ticket with the following descriptions:

Pawn Ticket No. : 40301SG039006

Amount : Php13,415.40
Descriptions : Gents Ring 21K 5.8grams

2. That the said pawn ticket while in my possession was misplaced and got lost;

3. That despite diligent search and efforts to locate the said pawn ticket, I could not
find the same such that I now believe that they are now lost beyond recovery.

4. 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

Mandaue City, Cebu, Philippines.

EDWILYN PASAOL
Affiant

SUBSCRIBED AND SWORN TO before me ______________ in Mandaue City,

Cebu, Philippines, affiant being personally known to me to be the same person who
executed the foregoing instrument.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2020.