Republic of the Philippines ]

City of Tagbilaran ] S.S.

AFFIDAVIT OF LOSS
(Re: Pawn Ticket)

I, IAN PRINCE WINCHEL A. QUIBEL, Filipino, of legal age, married and a

resident of Anislag, Maribojoc, Bohol, after being duly sworn in accordance with law,
hereby depose and say:

1. That sometime around year 2019 I pawned my one (1) BCG Necklace with
Pendant 12k 5.30g and one (1) BCG Necklace 18k 3.8g at Palawan Pawnshop,
Maribojoc Branch, Maribojoc, Bohol which I was issued two Pawn tickets
with Pawn Ticket No. 47075 and Pawn Ticket No. 47076, respectively;

2. That the said Two Pawn Tickets issued by Palawan Pawnshop were in my
possession but the same was misplaced;

3. That I exerted diligent efforts to find and recover the same, however, its
whereabouts still could not be ascertained, hence, I considered it to be lost, for
all intents and purposes;

4. That I never transferred the said Palawan Pawnshop Pawn Ticket No. 47075
and Pawn Ticket No. 47076 to any person for consideration;

5. That I execute this affidavit voluntarily to attest to the truth of the foregoing
statements for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I hereunto set my hand this 27th day of July 2020 at
Tagbilaran City, Bohol, Philippines.

IAN PRINCE WINCHEL A. QUIBEL

Affiant
Driver’s License ID No. G03-99-048325
Land Transportation Office

SUBSCRIBED AND SWORN TO before me this 27th day of July 2020 at

Tagbilaran City, Bohol, Philippines.

ATTY. RALP RYAN A. LAGURA, CPA

MAULAS & LAGURA Law Office
G/F Castelcelo Building 2 Gallares St,
corner J.S. Torralba St, Tagbilaran City
NOTARY PUBLIC until December 31, 2020
NCS No. 2019-68; TIN 263-686-047-000
Roll No. 72594, IBP Membership No. 089933
PTR No. 7958107, January 2, 2020; CY 2020
MCLE Compliance No. (TEMPORARILY EXEMPT)
For the City of Tagbilaran and Other Municipalities of Bohol