Republic of the Philippines )

Province of Rizal ) s.s

AFFIDAVIT OF LOSS

I, NORBERTA M. SALONGA, Filipino, widow, of legal age, and with

residence address at 39 Atis street Aurora Subdivision Angono, Rizal, after being
duly sworn to in accordance with law, hereby depose and state:

1. That I used to have with me a pawn ticket issued by Cebuana Lhuillier

with pawn ticket no. 61515SE002718;
2. That sometime last February 2020, the said pawn ticket was misplaced
and got lost;
3. That despite diligent search and efforts to locate the said pawn ticket, I
could not find the same such that I now believe that it is now lost beyond
recovery;

As such, I am executing this Affidavit of Loss to attest to the

truthfulness of the foregoing and to enable me to secure a duplicate or
substitute copy of the ticket and/or redeem the item/s which I pawned with
Cebuana Lhuillier.

IN WITNESS WHEREOF, I hereby set my hand this ______________ at

Angono, Rizal.

NORBERTA M. SALONGA
Affiant

SUBSCRIBED AND SWORN to before me this ______________ at Angono,

Rizal, Affiant exhibited to me her Senior Citizen ID, with the number
______________.

NOTARY PUBLIC

Doc. No. ___________

Page No. ___________
Book No. ___________
Series of 2020.