Republic of the Philippines)

Province of Southern Leyte) S. S.

City of Maasin...............)

AFFIDAVIT OF LOSS

I, NOVEE MARIE P. SALAS, of legal age, Filipino, single and a resident of Asuncion,
Maasin City, Southern Leyte, Philippines, after having been duly sworn to in accordance with
law, depose and say:

1. That sometime on September 2, 2022, I pawned my Huawei Matepad 10.4 4GB/64GB

for a principal amount of P3,500.00 with M Lhuillier (Maasin 1 Branch), located at
Combado Maasin City, for which I was issued Pawn Ticket or Receipt No. 0227-2022-
01271;

2. That sometime on October 2022, I lost my wallet, together with the aforesaid pawn
ticket or receipt slip;

3. That I have exerted my best efforts to locate and recover the aforesaid pawn ticket or
receipt slip, but despite diligent search made, my efforts proved futile. I now consider
the same irretrievably lost;

4. That the said pawn ticket or receipt slip has not been confiscated by any officer of the
law or by the issuing company due to violation of any law, rule or regulation;

5. That I am executing this affidavit to attest to the veracity of the foregoing, and for
whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set/affixed my signature this ___________________

at Maasin City, Southern Leyte, Philippines.

NOVEE MARIE P. SALAS

Affiant

SUBSCRIBED AND SWORN TO before me this _______________ at Maasin City, Southern

Leyte, Philippines.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2022.