REPUBLIC OF THE PHILIPPINES)

MABINI, PANGASINAN)S.S.

AFFIDAVIT

I, SHERMAN BAUTISTA MENDOZA ,of legal age, Filipino, marriedwith

residence and postal address at Poblacion, Mabinim Pangasinan, after having been duly
sworn to in accordance with law depose and say:

That I have pawned my Chain 3T 18k with CB ESTRADA Pawnshop with

business address at Alaminos City, Pangasinan and as evidence thereof said Pawnshop
issued to me PT no. 19844;

That the above-said ticket/receipt was unfortunately lost or misplaced by me and

diligent search proved futile;

That I am executing this affidavit to attest to the truth of the foregoing

circumstances and for the purpose of informing the pawnshop concerned so that its
unauthorized use can be forestalled.

That I have not assigned nor encumbered the afore-said ticket/receipt and I hereby
free and discharge the pawnshop from any liability whatsoever by reason of its
unauthorized use prior to this notice.

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

__________________________, in Mabini, Pangasinan, Philippines.

SHERMAN BAUTISTA MENDOZA

Affiant

SUBSCRIBED AND SWORN to before me this ___ day of

__________________________, in Mabini, Pangasinan, Philippines.

Doc. No. _____;

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