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Republic of the Philippines)

City of Zamboanga )s.s.


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

AFFIDAVIT OF LOSS

I, TERESITA P. COLUMNO, of legal age, single, Filipino citizen and a


resident of 584-A Canelar Moret, Zamboanga City, Philippines, after having been
duly sworn to in accordance with law, hereby depose and say, that:

1. I pawned a certain necklace with RD Pawnshop, with business


address at La Purisima Street, Zamboanga City and as such I was
issued a pawn ticket;

2. Said pawn ticket was kept in my wallet;

3. Sometime last week of March 2009, due to inadvertence my wallet got


lost;

4. I exerted diligent efforts to locate and look for my wallet in other places,
but the same proved futile;

5. For all intents and purposes, I am now declaring said pawn ticket lost
and beyond recovery;

6. I execute this Affidavit to attest to the truth of the foregoing facts based
on my personal knowledge and for whatever legal purpose it may
serve.

IN WITNESS WHEREOF, I have hereunto set my hand on this 4 th day of


March 2009 at Zamboanga City, Philippines.

TERESITA P. COLUMNO
Affiant

SUBSCRIBED AND SWORN to before me on this 4 th day of March 2009


in the City of Zamboanga, Philippines, Affiant exhibited to me her Community
Tax Certificate No. _________issued on_____________2009 at Zamboanga
City.

MARIA FE C. GAUGANO
NOTARY PUBLIC
Zamboanga City
Doc No._____ Until December 31, 2010
Page No.____ Notarial Commission No. 031-2009
Book No. IV PTR NO. 0017856-01/09/09
Series of 2009 IBP NO. 727090-01/08/09
Roll No. 53057-4/26/07

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