Republic of the Philippines )

Province of Cebu )S.S.

Cebu City )

AFFIDAVIT OF LOSS

I, CONRADO PLACENCIA TUYCO, of legal age, single, Filipino and a resident at Cogon,
Compostela, Cebu, after having been duly sworn to in accordance with law, do hereby depose
and state;

1. THAT I am the owner of Ring YG Def 20k 5.60gms. pawned at M Lhuillier

Compostela (Aggies) Branch on December 11, 2023 with Receipt No. 122601408 -
2023-00319 amounting to Php13,400.00;

2. THAT on February 20, 2024, I noticed that the Receipt of Pawning was either lost or
misplaced and nowhere to be found;

3. THAT diligent efforts were made for the recovery thereof but it proved futile and I
am of the belief that the said Receipt got lost and beyond the hope of recovery;

4. THAT I hereto request the Office or Branch of M Lhuillier to issue a New Copy of the
lost Receipt and in the event that the said Receipt be found and located, I bind
myself to surrender the same;

5. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing
and to support my application for the issuance of new Receipt in my favor.

IN WITNESS WHEREOF, I have hereunto set my hand this _______________________ at

Cebu City, Cebu, Philippines.

CONDRADO P. TUYCO
Valid ID: Driver’s License ID G05-18-000742
Affiant

SUBSCRIBED AND SWORN to before me this ____________ at Cebu City, Cebu,

Philippines.

Doc. No. ________;

Page No. ________;
Book No. ________;
Series of 2024