Republic of the Philippines)

City of Cagayan de Oro )S.S.

AFFIDAVIT OF LOSS

I, Nelia T. Balinado, Filipino, of legal age, and a resident of Zone 4 Upper,

Bulua, Cagayan de Oro City after having been sworn to in accordance with the law, do
hereby depose and say.

1. That I am the lawful holder of the Pawn Receipt No. 0343-2019-00715

duly issued by MLHUILLIER Pawnshop on April 23, 2019 in the amount of Php 15,500,00
with the description of Y6 Necklace Def. 10k 8.50 grams.

2. That the above mentioned Pawn Receipt where I placed inside my wallet
and it's in my possession , the latter was incidentally lost/misplaced and could no longer
be located despite diligent efforts to locate or search the same, to no avail.

3. That I am executing this affidavit to attest to the truth of the foregoing

facts to support to my reissuance of my aforementioned and for whatever legal purpose
this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 7th day

of_October,2019 in Cagayan de Oro City, Philippines.

NELIA T. BALINADO
Affiant

SUBSCRIBED AND SWORN to befor me this 7th day of October 2019 in

Cagayan de Oro City, Philippines.