Republic of the Philippines)

La Trinidad, Benguet) s.s

x- - - - - - - - - - - - - - - - -x

AFFIDAVIT OF LOSS OF PAWNSHOP RECEIPT

I, _____________, of legal age, single/married, Filipino, and currently a resident
of___________________, Philippines, after having been duly sworn to in accordance with law,
do hereby depose and state THAT:

1. Sometime in the year ______________, I constituted/pawned my personal

item/Cellphone in favour of Rena-Len Phone Shop and Trading Incorporated, located
at Km. 4, Balili, La Trinidad, Benguet with the following particulars:

Brand/Unit: ________ Due: ________

Amount: Php. _______ Code: ________

Serial Number: ______ .

2. Accordingly, I was issued a Pawnshop Receipt by Rena-Len Phone Shop and Trading
Incorporated, the said Pawnshop Receipt was kept inside my/our ___________ until
it got lost sometime on_______________, the facts of its loss were as follows;

After I pawned the item, where to my recollection I placed the said pawnshop
receipt at the ________________ for safekeeping, along with some personal
items. Sometime on _____________ at around 4:00 o’ clock in the afternoon, I
was supposed to get my Cellphone with the pawn shop agreement (“sangla”)
with Rena-Len Phone Shop and Trading Incorporated, I then looked and search
for the said pawnshop receipt inside of our Boarding House, but to my surprise
the said receipt was not in the place where I put the last time. It was then and
there that I realized that the same was missing or got lost.

3. I/We immediately search and exerted diligent effort to locate the same but all
my/our efforts were proved futile, fruitless and in vain as the same cannot be
located;

4. In view of the foregoing, I/we strongly believed that my said pawnshop receipt has
been inadvertently lost without any deliberate intent on my part whatsoever. I am
now of the honest and sincere belief that same is already lost and beyond recovery;

5. The loss of my said receipt is neither intentional nor use for any illicit activities but
due to the afore cited reason;

6. Finally, I am executing this affidavit to attest to the truthfulness of the foregoing

facts and for all legal intents and purposes it may serve well.

IN WITNESS WHEREOF, I have hereunto set my hand this 24th day of December 2020
at La Trinidad, Benguet, Philippines.

___________________
Affiant
Valid ID No. _________________

SUBSCRIBED AND SWORN to before me a Notary Public for and in La Trinidad,

Benguet, Philippines this 24th day of December 2020 the above Affiant exhibiting to me his/her
ID with picture above his/her name and identified by me to be the same person who personally
signed before me the foregoing Affidavit.

ATTY. CYRUS C. CALAYA

Doc. No. ____; Notary Public until Dec. 31, 2021
Page No. ____; PTR No. BGTCF 6232438, Jan. 10, 2020
Book No. ____; IBP Lifetime No. 08051, at Pasig City
Series of 2020. Roll No. 52590, May 12, 2006; Manila
S & B Bldg., FA 224, Km. 4 National Highway
La Trinidad, Benguet