REPUBLIC OF THE PHILIPPINES)

) S.S.

AFFIDAVIT OF LOSS

That I, MARICEL JOAQUIN, of legal age, Filipino Citizen, and with address at
##21 WACO ST. RANCHO 3 CONCEPCION DOS MARIKINA CITY, after having been
duly sworn to in accordance with law do hereby depose and say:

That I am the holder of PT#60671SG016770 (Pulcera 21k. 3gms. ) amount P 6,540

PT#60671SG016771 ( Pulcera 21k. 57.8gms. ) amount P 13,260 PT#60671SG019091
( DR ear 21k. 6.02gms .) amount P 14, 327.60 issued by: CEBUANA Lhuillier –
Panorama Marikina.

That sometime on September 18, 2019 the said PT#60671SG016770 (Pulcera 21k.
3gms. ) amount P 6,540 PT#60671SG016771 ( Pulcera 21k. 57.8gms. ) amount P 13,260
PT#60671SG019091 ( DR ear 21k. 6.02gms .) amount P 14, 327.60 was lost, due to
unexpected circumstances;

That diligent effort was exerted to locate the same but it yielded a negative result:

That I am executing this affidavit of loss to attest the truth of the foregoing facts and
for reporting/for replacement/ and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

_____________________________, ______________________, Philippines

MARICEL JOAQUIN
Affiant

SUBSCRIBED AND SWORN to before me this___________________ affiant

exhibiting to me his/ her CTC No. __________________ issued on ______________ at
_____________ Philippines.

Doc No. ________

Page No. ________
Book No. ________ Notary public
Series of 2019