Republic of the Philippines)

City of Zamboanga
)s.s.
X--------------------------------X
AFFIDAVIT OF LOSS
I, ELMA H. URING, of legal age, widow, Filipino citizen and a
resident of Nazareno Drive, Tugbungan, Zamboanga City, Philippines, after
having been duly sworn to in accordance with law, hereby depose and say
that:
1. I am the owner of that certain jewelry particularly described as:
1 Y6 Ring
2. Sometime on 12 July 2015, I pawned the above-described jewelry
with the MHLuiller with business address at Talon- Talon Loop,
Zamboanga City, Philippines, for and in consideration of FOUR
THOUSAND FOUR HUNDRED PESOS (P 4, 4000.00) Philippine
currency and as such I was issued a pawn ticket bearing no. 05872015-01160;
3. Said pawn ticket was usually kept inside my cabinet at our residence
for safe keeping;
4. However, due to inadvertence or oversight, I discovered that said
Pawn Ticket got lost and is no longer in my cabinet;
5. I exerted diligent efforts to locate for the same in other places but all
such endeavors proved futile and to no avail;
6. For all intents and purposes, I am now declaring the abovementioned Pawn Ticket lost and beyond recovery;
7. I execute this Affidavit to attest to the truth of the foregoing facts
based on my personal knowledge and authentic records in
compliance with requirement of MHLuiller the requirement and for
whatever legal purpose it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 24 th day
of August 2015 at Zamboanga City, Philippines.
ELMA H. URING
Affiant
SUBSCRIBED AND SWORN to before me on this 24th day of August
2015 in the City of Zamboanga, Philippines.
Doc. No. _____
Page No. _____
Book No. _____
Series of 2015