Republic of the Philippines )

Caba, La Union ) S.S.

AFFIDAVIT OF LOSS
(Pawn ticket)

I, ANNALYN E. ESTIGOY, of legal age, Filipino, and with residence and

postal address at Gana, Caba, La Union, after having been duly sworn to in
accordance with law depose and say:

That I have pawned my EARRING PAIR DORM (0.60 grams, 18 karats)

with Cebuana Lhuillier-___________________ Branch with business address at
________________________________________, for and in consideration of the sum
of PhP 1,300.00 as evidence thereof said pawnshop issued to me Ticket/receipt
bearing No. 60366sg032709 dated February 21, 2020;

That the above-said ticket/receipt was unfortunately lost or misplaced by

me and diligent search proved futile;

That I am executing this affidavit to attest to the truth of the foregoing

circumstances and for the purpose of informing the pawnshop concerned so
that its unauthorized used can be forestalled.

That I have not assigned nor encumbered the afore-said ticket/receipt

and I hereby free and discharge the pawnshop from any liability whatsoever by
reason of its unauthorized use prior to this notice.

IN WITNESS WHEREOF, I have hereunto set my hands this 22 nd day of

August, 2020 in Caba, La Union.

ANNALYN E. ESTIGOY,
Affiant

SUBSCRIBED AND SWORN to before me this 22nd day of August, 2020, in Caba, La
Union, by affiant who is personally know to me and personally signed the foregoing instrument
before me and avowed under penalty of law to the whole truth of the contents of the said
instrument.

MHELANIE CARREON WILLIAM

Doc. No.: 190 Notary Public until December 31, 2020
Page No.: 39 Notarial Commission 2019-01-BG
Book No.: XLIX PTR No. 4845952/01-10-2020
Series of 2020. Roll of Attorney 64072:04-27-15