REPUBLIC OF THE PHILIPPINES )

Province of Nueva Ecija ) S.S.

Science City of Munoz )

AFFIDAVIT OF LOSS

I, ARLENE STO. DOMINGO, of legal age, Filipino, presently residing at

Barangay Bakal III, Talavera, Nueva Ecija, after having been sworn to in
accordance with law, hereby depose and state, THAT:

1. I pledged my jewelry with the Cebuana Lhuiller Pawnshop 20409

Muñoz 1 Science City of Muñoz, Nueva Ecija described as the
following:

a. Pawnshop Ticket No. 20409SG026533- Terno 18k, 17.70 grams

b. Pawnshop Ticket No. 20409SG026534- Pulcera 18k, 6.1 grams
c. Pawnshop Ticket No. 20409SG026535- Pulcera 18k, 7.6 grams
d. Pawnshop Ticket No. 20409SG026536- Pulcera 14k, 11.60 grams
e. Pawnshop Ticket No. 20409SG026537-Pulcera 14k, 12.30 grams
f. Pawnshop Ticket No. 20409SG026538- Terno 21k, 16.80 grams
g. Pawnshop Ticket No. 20409SG026539- Necklace 21k, 9.3 grams
h. Pawnshop Ticket No. 20409SG026540- Pulcera 18k, 5.4 grams
i. Pawnshop Ticket No. 20409SG026541-Necklace with pendant
21k, 7.70 grams
j. Pawnshop Ticket No. 20409SG026542-Terno 14k, 11.10 grams
k. Pawnshop Ticket No. 20409SG026543- Lady Ring 10k, 5.2 grams
l. Pawnshop Ticket No. 20409SG026544-Lady Ring 22k, 5.3 grams
m. Pawnshop Ticket No. 20409SG026545-Necklace 21k, 6.3 grams
n. Pawnshop Ticket No. 20409SG026546-Lady Ring 22k, 3.6 grams
o. Pawnshop Ticket No. 20409SG026547-Necklace 18k, 3.4 grams
p. Pawnshop Ticket No. 20409SG026548-Lady Ring 18k, 3.2 grams
q. Pawnshop Ticket No. 20409SG026549-Pendant 18k, 2.0 grams
r. Pawnshop Ticket No. 20409SG026550-Lady Ring 14k, 3.5 grams

2. That the said Pawnshop Receipt was lost and could not be found
anymore despite my effort to locate the same;

3. I have executed this affidavit to attest to the truthfulness of the

foregoing facts, to inform the Cebuana Lhuiller Pawnshop 20409
Muñoz 1 of the fact of the loss and to request to furnish me a new
one and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this June 2.

2019 at Science City of Munoz, Nueva Ecija.

ARLENE STO. DOMINGO

Affiant
 SUBSBRIBED and SWORN to before me this June 2, 2019 at Science City
of Munoz, Nueva Ecija and I hereby certify that the affiant has read the contents of
her affidavit and understands the same.

Doc No. ____;

Page No. ____;
Book No. VI;
Series of 2019.
REPUBLIC OF THE PHILIPPINES )
Provinceof NuevaEcija ) S.S.
ScienceCity of Munoz )

AFFIDAVIT OF LOSS

I, MARILOU C. ARIOLA, of legal age, Filipino, married, presently residing

at Purok 2 Barangay Rang-Ayan, Science City of Muñoz, Nueva Ecija, after
having been sworn to in accordance with law, hereby depose and state, THAT:

4. I pledged my 14k earring (7.5 grams) with the Cebuana Lhuiller

Pawnshop 20409 Muñoz 1 Science City of Muñoz, Nueva Ecija
and a corresponding Pawnshop Ticket No. 20409SG 017804 was
issued in my name indicating the description of the item pledged
and the amount of loan for P 8,500.00;

5. That the said Pawnshop Receipt was lost and could not be found
anymore despite my effort to locate the same;

6. I have executed this affidavit to attest to the truthfulness of the

foregoing facts, to inform the Cebuana Lhuiller Pawnshop 20409
Muñoz 1 of the fact of the loss and to request to furnish me a new
one and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this March

26, 2019 at Science City of Munoz, Nueva Ecija.

MARILOU CARAMAT ARIOLA

Affiant
VIN: 4917-0151A-E2689MCA 20000
COMELEC, Science City of Munoz, Nueva Ecija
 SUBSBRIBED and SWORN to before me this March 26, 2019 at Science
City of Munoz, NuevaEcija and I hereby certify that the affiant has read the
contents of her affidavit and understands the same.

Doc No. ;
Page No. ;
Book No. VI;
Series of 2019.