REPUBLIC OF THE PHILIPPINES 

)
QUEZON CITY                  )SS.
X-----------------------------------------X
  
AFFIDAVIT OF LOSS
 
I, XXX, Filipino, of legal age, married and a resident of 14 Dagot St.
near corner Banawe St Manresa, Quezon City Philippines, after having
duly sworn to in accordance with law,  hereby depose and say that:

1. On 16 November 2020, at about 9:00 a.m., I lost my wallet

while riding as a passenger on a tricycle around Barangay XXX
going home.

2. I lost the following Cebuana Lhuillier – NS Amoranto pawn tickets

along with said wallet:

1.) Pawn ticket no. XXX with principal amount of Php9,750.00

expiring on 18 November 2020; and

2.) Pawn ticket no. XXX with principal amount of Php9,250.00

expiring on 18 November 2020;

  
3.   I exerted all efforts to locate the same but I do not know
exactly where it drop from my bag and it is considered lost for all
legal purposes;

4. I am executing this affidavit to attest to the foregoing facts;

 
IN WITNESS WHEREOF, I have hereunto set my hand this 17th day
of November 2020 in Quezon City, Philippines.
 
 
                                           XXX
     Affiant
 

SUBSCRIBED AND SWORN to before me this 17 th day of November

2020 in Quezon City, Philippines, affiant having exhibited to me her SSS
ID No. XXX issued at Quezon City.
 
Doc. No.____;
Page No.____;
Book No.____;
Series of 2020.