Republic of the Philippines…}

Province of Surigao del Sur…}

City of Tandag…} S. S.

AFFIDAVIT OF LOSS

I, DELMA P. SANORIA, Filipino, of legal age and a resident of Brgy. Awasian,

Tandag City, Surigao del Sur, state under oath, THAT:

1. I pawned my Gold Necklace at Cebuana Lhuillier located at Osmeña St.,

Tandag City, Surigao del Sur for which I was issued a receipt;

2. I kept said receipt in one of my folders which contain also other important
documents;

3. However, the folder which contains my receipt and other important documents
cannot be found in the place where I kept it;

4. I exerted all efforts to locate the same but to no avail;

5. I am executing this Affidavit to attest the truthfulness of the foregoing

statements and for any legal purpose this may serve best.

IN WITNESS WHEREOF, I have hereunto set my hand this 7 th day of July 2015,
in Tandag City, Surigao del Sur, Philippines.

DELMA P. SANORIA
ID No. __________
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, a Notary Public for and in the
Province of Surigao del Sur, this 7 th day of July 2015, in Tandag City, Surigao del Sur,
the affiant personally appeared and affixed her signature and presented her ID as proof
of her identity.

Doc. No. _____

Page No. _____
Book No. _____
Series of 2015