Republic of the Philippines)

City of Davao )
x-----------------------------------x

AFFIDAVIT OF LOSS

I, MARCELYN MONATO, Filipino citizen, at legal age, single and a

resident of Prk. 13 Prosperidad, Agusan del Sur, after having been duly sworn to
in accordance with law hereby depose and state:

1. THAT I am a bonafied holder of Pawn Paper issued by Cebuana

Lhuillier Ilustre branch with the following details;

a. Pawn ticket No. 61438SG001996

b. Item Description : Necklace with cont. Pendant
c. Loan Date: June 6, 2019
d. Expiry Date: October 7, 2019
e. Principal Amount: 7,300

2. THAT Recently however, when I checked my personal effects, I

noticed that the said Pawn Paper was no longer tucked in my wallet, I
checked my other bags but the Pawn Paper was not placed there
either;

3. THAT I exerted earnest efforts to locate the said Pawn Paper but the
same could not be found and I have lost hope of ever finding the same;

4. THAT I am executing this affidavit of Loss to attest to the truth of the

foregoing facts and for the purpose of securing a new Pawn Paper by
Cebuana Lhuillier.

IN WITNESS WHEREOF, I have hereunto set my hand this 18th day of

October 2019 at Davao City, Philippines.

MARCELYN MONATO
Affiant
LICENCE ID No. K08-18-005547

SUBSCRIBED AND SWORN to before me this 18th day of October 2019at

Davao City, Philippines.

Doc No. ________;

Page No.________;
Book No. _______;
Series of 2019.