Republic of the Philippines}

In the City of Pagadian. . .} S.S.

X-------------------------------------- /

AFFIDAVIT OF LOSS

I, JEVERLY S. DURATO, of legal age, single, Filipino, and a resident of

Bokong, Labangan, Zamboanga del Sur, after having sworn to an oath, hereby
depose and state that:

1. I am the holder of the Official Receipt of a pawned ASUS Cellphone at

PAG-ASA Pawnshop, with an amount of P 1,800.00;

2. That the said receipt was lost and its whereabouts cannot be
ascertained despite due and diligent search made and undertaken;

3. That I tried to search it in an attempt to recover the receipt, but the

search ended in futility;

4. That I truly believe that the said receipt is lost forever;

5. Finally, I am executing the instant affidavit to attest to the truth of the

foregoing averments and in order to support for the release of the said
pawned item.

IN WITNESS WHEREOF, I hereby affix my signature this 6th day of

February, 2020, at Pagadian City, Philippines.

JEVERLY S. DURATO
Affiant

SUBCRIBED AND SWORN TO before me, this 6th day of February,

2020, the affiant presented her ID bearing her signature and
photograph, with the specifics as above-stated, and he affirmed to me
that she understood the contents thereof, after the same was translated
to him in the Bisayan dialect, of which she is conversant.

Doc. No.:________
Page No.:_______
Book No.:________
Series of 2020.