Republic of the Philippines)

CITY OF ZAMBOANGA. . . . . ) S.S.

x- - - - - - - - - - - - - x

AFFIDAVIT OF LOSS

I, ___________________, of legal age, married, and residing

at __________________, Zamboanga City, after having been sworn in
accordance with law, hereby depose and say:

That I have pawned at the CEBUANA LHUILLIER PAWNSHOP,

Macatulad Bldg., La Purisima, Zamboanga City, personal property
for which the said pawnshop issued to me the Pawn Tickets as
follows:
Date Article Amount Pawn Ticket
Number

08-02-13 1 Pc Wding Ring 21K 2.7grms P 4,400.00 50311SGO20068

That due to our evacuation from our home at the height of

the crisis in Zamboanga City which started on September 9, 2013,
the said pawn ticket was lost or misplaced in such a way that its
whereabouts have become completely unknown;

That I have exerted diligent efforts in the search for the

said pawn ticket but all proved futile and that the same is now
beyond recovery;

That I am executing this affidavit in order to establish the

loss of the said Pawn Ticket as a fact in connection with my
desire to redeem the pawned property above-described and for all
the purposes that this may serve under the law;

IN WITNESS WHEREOF, I have hereunto set my hand on this ___

day of _____________ in the City of Zamboanga, Philippines.

___________________
Affiant

SUBSCRIBED AND SWORN to before me on this ____ day of

________ in the City of Zamboanga, Philippines.

Doc. No.____; Page No. ___;

Book No. ___; Series of 2013