REPUBLIC OF THE PHILIPPINES)

CITY OF TACLOBAN            ) S.S.

x----------------------------x
  
 
AFFIDAVIT OF LOSS
 
 
 I, MARILOU BORINAGA ONREJAS, of legal age, Filipino, single and
a resident of Brgy. 74, Nula-Tula, Tacloban City, after having been duly
sworn to in accordance with law, depose and state THAT:
 
1. I am the owner of a ring particularly Y6 Deformed with Dias missing;
 
2.I pawned the same ring to M Lhuillier Philippines (Zamora St. Branch) on
June 1, 2022 with an amount of Five Thousand Two-hundred Fifty pesos
(P5,250) with receipt number 199-2022-00431;
 
3. The said ring while in my possession were misplaced and could no longer
be located in spite of diligent efforts to locate them;
 
4. Said ring was neither transferred to other persons/entity/financial
institutions for any consideration nor encumbered to guarantee financial
obligations with any financial institution;
 
7. I am executing this affidavit to attest to the veracity of my statements and
to support payment of the interest at M Lhuillier Philippines of my lost ring.
 
IN WITNESS WHEREOF, I have hereunto set my hand this 2nd December
2022 in Tacloban City, Philippines.
 
 

MARILOU BORINAGA ONREJAS

Affiant
SSS ID No. 06-1196709-5

 SUBSCRIBED AND SWORN TO before me this 2nd December 2022 in

Tacloban City, Philippines, affiant exhibiting to me his/her competent
evidence of identity by way of SSS ID issued at Tacloban City on January
2004.
 
 
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2022.