REPUBLIC OF THE PHILIPPINES)

PROVINCE OF NORTHERN SAMAR) S.S.

MUNICIPALITY OF LAOANG)

AFFIDAVIT OF LOSS OF PAWN TICKET

I, VANESSA D. SUNGA, of legal age, Filipino, married, and a resident of

Barangay San Miguel Heights, Laoang, Northern Samar, under oath, hereby
depose and state:

1. That I pawned to CEBUANA LHULLIER, at Laoang, Northern Samar,

on June 4, 2015, with the item of Necklace Gold Whisper;
2. That the said items was pawned for an amount of Thirteen
Thousand Seven Hundred six Pesos only (Php 13, 706.00) and covered by
pawn Receipt No. 60434SG008349;
3. That sometime in the month of June 2015, I was looking for my
said CEBUANA Pawned Receipt as I planned to renew the transaction but I
could not find said receipts anywhere in the house;
4. That I execute this affidavit of loss for the purpose of redeeming
said pawned items to avoid the same to be sold or auctioned off to the
public;
5. That I execute this affidavit to attest to the truth of the foregoing
statements particularly of informing the CEBUANA LHULLIER of the fact of
such loss, and for whatever legal intents and purposes this may serve.

IN WITNESS WHEREFOF, I have hereunto set my hand this 4th th day of

August, 2015, at Laoang, Northern Samar, Philippines.

VANESSA D. SUNGA
Affiant

SUBSCRIBED AND SWORN to before me this 4th day of August, 2015,

at Laoang, Northern Samar, Philippines, affiant exhibiting to me her PRC Id
No: 1126486 .

ATTY. ERWIN T. DRIO

Public Attorney II
(Pursuant to R.A.9406)