REPUBLIC OF THE PHILIPPINES

)
DASMARINAS, CAVITE . . . . . . ) S.S.

AFFIDAVIT OF LOSS
I, MYRA RIZZA S. GELLE, Filipino, of legal age and residing Zone I-A,
Dasmarias, Cavite, after being duly sworn to in accordance with law,
depose and state: That - 1.

I am the holder of the following I.Ds to wit:

ATM, Credit Card, (BPI), Drivers License Non-Prof. issued at
Sabang Dasma by the LTO and Medo Care Health Card.

2.

Unfortunately, on 31st of May 2010, my wallet containing the

above-mentioned I.D. Cards was lost in my possession which I
believed it was stolen at the clinic.

3.

I exerted sincere efforts to locate and to recover the same but all
my efforts proved futile;

4.

I am executing this affidavit to attest to the truth and veracity of

the foregoing and for whatever legal purpose the same may serve;

IN WITNESS WHEREOF, I have hereunto affixed my signature this

1 of day of June 2010 in Dasmarias City, Cavite.
st

MYRA RIZZA S. GELLE

Affiant
SUBSCRIBED AND SWORN to before me this 1ST day of June 2010 in
Dasmarias City , Cavite. Affaint exhibiting to me her SSS I.D. No. 33-3291849-8
issued at Bacoor, Cavite.

Doc. No. 275;

Page No.56;
Book No. IX;
Series of 2010.

REPUBLIC OF THE PHILIPPINES

)
DASMARINAS, CAVITE . . . . . . ) S.S.

AFFIDAVIT OF LOSS
I, LORNA L. ARCEO, Filipino, of legal age and residing at Blk. 12, Lot
14, Bgy. Emmanuel I, Dasmarinas, Cavite, after being duly sworn to in
accordance with law, depose and state: That - 1.

I am a holder of a pawn ticket issued by M. Lhuillier-Bgy.

Emmanuel Branch, with no. 41096, covering my pledge of one
pulceras with magnet;

2.

Recently, I fouind out that the afore-said pawnticket was

misplaced, lostn and/or missing;

3.

I exerted sincere efforts to locate and to recover the same but

all my efforts proved futile;

4.

I am executing this affidavit to attest to the truth and veracity of

the foregoing and for whatever legal purpose the same may
serve;

IN WITNESS WHEREOF, I have hereunto affixed my signature this

09 day of June 2009 in Dasmarinas, Cavite.
th

LORNA L. ARCEO
Affiant
SUBSCRIBED AND SWORN to before me this 09th day of June 2009
at Dasmarinas, Cavite. Affaint exhibiting to me her Community Tax Cert. No.
09018673 issued on 07.13.09 at Dasma., Cavite.
Doc. No. 140;
Page No. 28;
Book No. 107;
Series of 2009.

Notary Public