REPUBLIC OF THE PHILIPPINES)

CITY OF GENERAL SANTOS…….) S.S.

X-----------------------------------X

AFFIDAVIT OF LOSS

I, EDELYN RAMIREZ TORIBIO, Filipino, of legal age, and a resident of Sitio

Sodako Malalag Cogon, Malungon, after being duly sworn to in accordance with law,
hereby depose and say:

1. That I pawned 1.00 0 YG PR DEF 0.00 Y1 105 1.20, with Mlhuillier,

General Santos City, with the following details:
PRINCIPAL AMOUNT : Php 2,700.00
DATE PAWNED : June 5, 2022
DESCRIPTION : 1.00 0 YG PR DEF 0.00 Y1 105 1.20
2. That I had the said pawn ticket placed inside my wallet for safe-keeping and
future reference;
3. Lately, I tried to retrieve the above-mentioned pawn ticket; however, I
discovered that the same was already lost and could no longer be found;
4. That despite diligent efforts to locate and find said pawn ticket, the same
could no longer be found and is now beyond recovery;
5. That I execute this affidavit to attest to the truth of the foregoing and for
all legal purposes.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this _________________, in

General Santos City, Philippines.

___________________________
EDELYN RAMIREZ TORIBIO
Affiant

SUBSCRIBED AND SWORN TO before me this _____________________, in General

Santos City by affiant who exhibited to me her valid identification card: _______________.

Doc. No. ;
Page No. ;
Book No. ;
Series of 2022.