REPUBLIC OF THE PHILIPPINES}

MUNICIPALITY OF PATEROS } S.S.

METRO MANILA }

AFFIDAVIT OF LOSS PAWNTICKET

I, MYRNA CAREL, of legal age, Filipino and resident of E. Hermosa

Street, Pateros, Metro Manila, under oath depose and say that –

1. I pawned one (1) necklace with pendant/ 18k (2.5 grams) at

Cebuana Lhuillier Pawnshop under Pawn Ticket No.
10908SG022900 on February 24, 2020.

2. I have been keeping subject Pawn Ticket in my wallet.

3. However, sometime in April 2020, I noticed that the

aforementioned Pawn Ticket was missing in my wallet, either it
was misplaced, fell out from my wallet or accidentally disposed.

4. I exerted diligent effort to locate the said Pawn Ticket, but proved
futile, hence, I considered the same already lost and beyond
retrieve.

5. I hereby set free and harmless the said Pawnshop from any
liabilities or suit arising from the said lost Pawn Ticket or the item
described therein.

6. I am executing this affidavit to attest the truth of the foregoing and

for whatever legal purposes this may serve.

IN WITNESS WHEREOF, I affixed my signature this ____ day of

May 2020 at Pateros, Metro Manila.

MYRNA CAREL
Affiant

SUBSCRIBED AND SWORN to before me this ____ day of May

2020 with Affiant affixing his signature in my presence and within my
notarial jurisdiction.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2020