REPUBLIC OF THE PHILIPPINES )

PROVINCE OF LANAO DEL NORTE ) S.S

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

AFFIDAVIT OF LOSS

I, EMMA, of legal age, Filipino, and a resident of Lanao del Norte,

Philippines, after having been duly sworn to in accordance with law depose and
say:

1. That I have pawned my necklace Gold I14 (16.10 grams) with Cebuana
Lhuiller –_________ Branch, Lanao del Norte, for and in consideration of
the sum of P22,942.71 and as evidence thereof said pawnshop issued to
me Receipt bearing No. 64677NP001653, dated 09 September 2023;

2. That the above-said Receipt was unfortunately lost or misplaced in one of

my bags;

3. That all earnest efforts I exerted to locate the same in my bag and in the
house, but to no avail;

4. I am executing this Affidavit to attest to the truth of the foregoing facts,

and for whatever any and all legal purposes that this Affidavit may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of

October 2023 in Lanao del Norte, Philippines.

EMMA
Affiant

SUBSCRIBED AND SWORN TO before me this ___ day of October 2023 in

Lanao del Norte by affiant with her valid identification. I hereby examined the
AFFIANT that I am satisfied that she voluntarily executed and understood the
foregoing AFFIDAVIT.