Republic of the Philippines)

La Trinidad, Benguet) s.s

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AFFIDAVIT OF LOSS OF PAWNSHOP RECEIPT

I, Marilou Ejapon, of legal age, married, Filipino, and currently a resident of Balili, La
Trinidad, Benguet, Philippines, after having been duly sworn to in accordance with law, do
hereby depose and state THAT:

1. Sometime in the year December 2020, I constituted/pawned my personal

item/Cellphone in favour of Rena-Len Phoneshop and Trading Incorporated, located
at Km. 4, Balili, La Trinidad, Benguet with the following particulars:

Brand/Unit: RealMe 7i Due: December 12, 2020

Amount: Php. 3,000.00 Code: LT 0038D

Serial Number: 76931 .

2. Accordingly, I was issued a Pawnshop Receipt by Rena-Len Phone Shop and Trading
Incorporated, the said Pawnshop Receipt was kept inside our Boarding House until it
got lost sometime on December 2020, the facts of its loss were as follows;

After I pawned the item, where to my recollection I placed the said pawnshop
receipt at the top of our refrigerator for safekeeping, along with some personal
items. Sometime on December 23, 2020 at around 4:00 o’ clock in the afternoon,
I was supposed to get my Cellphone with the pawn shop agreement (“sangla”)
with Rena-Len Phone Shop and Trading Incorporated, I then looked and search
for the said pawnshop receipt inside of our Boarding House, but to my surprise
the said receipt was not in the place where I put the last time. It was then and
there that I realized that the same was missing or got lost.

3. I therefore immediately tried to search the same and even asked my family
members but I was unable to find it despite diligent effort. In view of the foregoing,
I strongly believed that my said pawnshop receipt has been inadvertently lost
without any deliberate intent on my part whatsoever. Therefore, I considered it lost
and beyond recovery;

4. The loss of my said receipt is neither intentional nor use for any illicit activities but
due to the afore cited reason;

5. Finally, I am executing this affidavit to attest to the truthfulness of the foregoing

facts and for all legal intents and purposes it may serve well.

IN WITNESS WHEREOF, I have hereunto set my hand this 24th day of December 2020
at La Trinidad, Benguet, Philippines.

Marilou Ejapon
Affiant
Phil. Health No. 04-250762830-8

SUBSCRIBED AND SWORN to before me a Notary Public for and in La Trinidad,

Benguet, Philippines this 24th day of December 2020 the above Affiant exhibiting to me her ID
with picture above her name and identified by me to be the same person who personally signed
before me the foregoing Affidavit.

ATTY. CYRUS C. CALAYA

Doc. No. 17; Notary Public until Dec. 31, 2021
Page No. 05; PTR No. BGTCF 6232438, Jan. 10, 2020
Book No. II; IBP Lifetime No. 08051, at Pasig City
Series of 2020. Roll No. 52590, May 12, 2006; Manila
S & B Bldg., FA 224, Km. 4 National, Highway
La Trinidad, Benguet