REPUBLIC OF THE PHILIPPINES)

ILOILO CITY )Sc.

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AFFIDAVIT OF LOSS
(Pawnshop Receipt)

I, MERLENE T. QUINDIPAN, of legal age, single, Filipino and residing at Brgy.

Desamparados, Jaro, Iloilo City, under oath, depose and state THAT:

1. I am the owner of a pair of 18k gold earring weighing approximately 1.10 grms.;

2. Sometime last December 09, 2019, I pawned my above-described jewelry at M.

Lhuillier Pawnshop, located at Rizal St., LaPaz, Iloilo City;

3. I was issued a pawnshop receipt as evidence of the transaction, to wit:

Receipt No. Loan Date Prin. Amt. Description

0258-2019-03980 12/09/2019 Php 2,000.00 1 pr.DORMV6 18k 1.10 grms.

4. I kept the above-described pawnshop receipt in our house;

5. Recently, when I tried to locate the above-described pawnshop receipt, I could no

longer find the same;

6. Despite exerting diligent efforts to locate said pawnshop receipt, it could no longer
be found and I now consider said pawnshop receipt lost and beyond recovery for all legal
intents and purposes;

7. I then informed the pawnshop of the loss of the aforementioned pawnshop

receipt/s; and

8. I am executing this affidavit to attest to the fact of the loss of the Pawnshop
Receipt and for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hands this 30th day of June 2020, in
the City of Iloilo Philippines.

MERLENE T. QUINDIPAN
Affiant

SUBSCRIBED AND SWORN to before me this 30th day of June 2020 in the City of
Iloilo, Philippines, affiant exhibiting to me his/her Competent Evidence of Identification: PRC
I.D. No. 0027654 valid until 04-23-2023 .

Doc. No.: 335 ;

Page No.: 58 ;
Book No.: XXVI;
Series of 2020.