REPUBLIC OF THE PHILIPPINES )

Province of Zamboanga Del Sur ) S.S.

City/Municipality of Ramon Magsaysay)
x-----------------------x

AFFIDAVIT OF LOSS

I, RHEA JUDILLA Filipino, of legal age, single, and a resident of Purok 3,

Barangay Bambong Diut, Ramon Magsaysay, Zamboanga del Sur, Philippines, after
being duly sworn in accordance with law, depose and state:

1 That on April 3, 2023, I pawned my W6 Pair w/ Charms Def 18K 3.8 grams
with MLhuiller Philippines located at IBJT Grounds, Ramon Magsaysay,
Zamboanga del Sur and for which I was issued Pawn Ticket/Receipt No.
0846-2023-00634.

2 That sometime on April 2023, my wallet that contains the said Pawn Ticket/
Receipt No. was misplaced and got lost.

3 That despite diligent search and efforts to locate the said wallet and pawn
ticket/receipt no., I could not find the same such that I now believe that they
are now lost beyond recovery.

4 As such, I am executing this Affidavit of Loss to attest to the truth of the

foregoing facts

IN WITNESS WHEREOF, I have hereunto set my hand this 23rd day of October
at Ramon Magsaysay, Philippines.

RHEA JUDILLA
Affiant

SUBSCRIBED AND SWORN to before me, this 23rd day of October 2023 in the
Municipality of Ramon Magsaysay, Zamboanga Del Sur. Affiant exhibited to me her
LRN No. 125309110011.

Doc. No. ______;

Page No. ______;
Book No.______;
Series of 2023.