Republic of the Philippines))

La Trinidad, Benguet) s.s

x- - - - - - - - - - - - - - - - -x

AFFIDAVIT OF LOSS

I, Jodelyn Aguila Angayen, of legal age, Filipino citizen, and a resident of No. 39, Kisad
Road, Baguio City, after having duly sworn to in accordance with law, do hereby and depose and
state THAT:

1. I am a bona fide holder of a Cebuana Lhuiller Pawnshop (Cebuana) Ticket Nos.

60068SG018071 over a lady’s ring modern des def (18 karat) 2.2 grams which I
pawned sometime on 2nd of December 2017 with maturity date of January 2, 2018.

2. After I pawned the said item with Cebuana, I kept the said receipt inside the drawer
of my table inside our boarding house then at JC-096, Km. 5, Pico, La Trinidad,
Benguet until lately, when we transferred residence from Pico, La Trinidad to Kisad
Road, Baguio City on the last week of December 2017.

3. While we were transferring our belongings and household utensils, materials and
things to Kisad Road, Baguio City, including the table where I kept the
aforementioned receipt, I was of the impression that the same was still inside the
drawer’ Thereafter however, when I tried to locate the said receipt, purposely in
preparation for the renewal of my pawn contract with Cebuana this January 2018, I
was surprised to noticed that it was no longer there. I then and there realized that the
same was missing and nowhere to be found;

4. Despite diligent efforts exerted to locate my Cebuana Pawnshop Receipt, my efforts

failed. By virtue of these circumstances, I therefore considered the same as lost and
beyond recovery;

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

6. I am executing this Affidavit to attest to the truth of the foregoing facts and for all
legal intents and purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 30th day of December 2017
at La Trinidad, Benguet, Philippines.

Jodelyn Aguila Angayen

Affiant
UMP ID. No. CRN-0111-4479361-2

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

Benguet, Philippines this 30th day of December 2017 by the above Affiant, after exhibiting to me
her Valid ID and identified by me of her Identity to be the same person who personally signed
before me the foregoing Affidavit.

ATTY. CYRUS C. CALAYA

Doc. No. 11; Notary Public until Dec. 31, 2017
Page No. 3; PTR No. BGT 5080030, February 15, 2017
Book No. III; IBP Lifetime No. 08051, at Pasig City
Series of 2017. Roll No. 52590, May 12, 2006; Manila
S & B Bldg., FA 224, Km. 4
National, Highway La Trinidad, Benguet