Republic of the Philippines)

City of Butuan……………..)S.S.
x----------------------------------x

AFFIDAVIT OF LOSS

I, RAYNEL VALENZUELA SANTOS, of legal age, Filipino and a resident of 10-1, Baluyot,
Buezon City, Philippines, after having been duly sworn to in accordance with law, do hereby
depose and state that:

1. I pawned an 18 karat gold necklace (3.6 grams) worth Seven Thousand One Hundred Six
Pesos (P7,106.00) from Cebuana Lhuillier Pawnshop located at Quezon City, Philippines;

2. As a result and as material proof of the pledge, I was issued with a corresponding Official
Receipt by the said pawnshop with Pawn Ticket Number 60736SG019817;

3. The said Official Receipt and Bus Ticket were inadvertently lost in my possession and
despite diligent efforts to locate the same could no longer be found;

4. Diligent efforts to locate the said Official Receipt proved futile and unavailing, thus, the
same is now BEYOND RECOVERY; And,

5. I am executing this Affidavit to show proof of the foregoing facts and for whatever legal
purpose it may serve.

IN WITNESS WHEREOF, I do hereby set my hand this 04 February 2020 in Butuan City,
Philippines.

RAYNEL VALENZUELA SANTOS

Affiant

SUBSCRIBED AND SWORN to before me, this 04 February 2020 in Butuan City,
Philippines. Affiant exhibited his Professional Driver’s License No. N25-13-032479 issued on 07-
13-2016 by the Land Transportation Office, and is personally known to the undersigned Notary
Public.

Doc. №:________________;
Page №:________________;
Book №:________________;
Series of 2019.