REPUBLIC OF THE PHILIPPINES )

CITY OF MUNITNLUPA ) S.S

AFFIDAVIT OF LOSS

I, EMILIA TAPAY SARMIENTO, of legal age, Filipino, and with residence and postal address
#110 Tensuan Site Katihan, Brgy. Poblacion, Muntinlupa City, Philippines, after having been duly
sworn to in accordance with law, do hereby depose and say:

1. That I am the owner/ holder of a 1 chain twisted 18k 8g 56 cm yg with deft. with Pawn
Ticket No. 49795 pawned at AGENCIA DE EMPEÑ OS DE MYRNA B. AGUIRRE INC.
located Brgy. Poblacion, Muntinlupa City amounting to TWELVE THOUSAND FIVE
HUNDRED Pesos (Ph 12,500.00) on January 20, 2020;

2. That the said PAWN TICKET was misplaced/ lost on January 21, 2020 in the vicinity
of our house in Muntinlupa City;

3. That despite of diligent effort to locate the aforesaid PAWN TICKET/ documents, the
same were proved to be futile;

4. That I execute this affidavit in order to attest the truth of the above facts for all legal
intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand and affix my signature this 30 th day of
January, 2020 in the City of Muntinlupa, Philippines.

EMILIA TAPAY SARMIENTO

Affiant

SUBCRIBED AND SWORN to before me this 30th day of January, 2020, in the City of
Muntinlupa, Philippines, affiant having exhibited to me a current Competent Identification with ID
No. 33876 issued by the OSCA, City Gov’t of Muntinlupa.

Doc. No. 77;

Page No. 17;
Book No. VII ;
Series of 2020.