REPUBLIC OF THE PHILIPPINES )

PROVINCE OF CAVITE )S.S.

MUNICIPALITY OF IMUS )

AFFIDAVIT OF OWNERSHIP & LOST - PAWNTICKET

I, HERMINIA P. DELA CRUZ, of legal age, Filipino, and with postal and
residence address at Blk 25 Lot 21 Ph1 Golden City Subd., Anabu II-F, Imus, Cavite, ,
after having been duly sworn to in accordance with law hereby depose and say:

That I am the owner of a necklace with pendant with pendant which I pawned
last January 4, 2010 at RYAN FRANZ PAWNSHP located at Diamond Village, Imus,
Cavite, and for which I was issued pawnticket No. 1757;

That I used to keep the said pawnticket at home. I later found out that the said
pawnticket is missing;

That despite diligent efforts to locate the said document, the same are still missing
and considered lost.

That I am executing this affidavit to attest to the truth of the foregoing for all legal
intents and purposes.

IN WITNESS WHEREOF, I have hereunto set my hand this 23 rd of April 2010

at Imus, Cavite, Philippines.

HERMINIA P. DELA CRUZ

(Affiant)

SUBSCRIBED AND SWORN to before me on the day and place above-written,

affiant exhibiting to me her I.D No.________________ issued on _______________ at
______________________.

Doc. No._______;
Page No._______;
Book No._______;
Series of 2010.