REPUBLIC OF THE PHILIPPINES 

)
CITY     OF      CEBU                  )SS.
X-----------------------------------------X
 
 
AFFIDAVIT OF LOSS
 
I, MARIA LENNIE DAANOY, Filipino, of legal age, single and a resident
of BRGY. BAWO, SOGOD, CEBU, Philippines, after having duly sworn to in
accordance with law,  hereby depose and say that:
 
1. I am the holder of M LHUILLIER RECEIPT detailed below:

Receipt No.: 0095-2022-01888

Amount: 4,000.00
Date Pawned month: November 22,2022
Description(s) Bracelet YG DEF 18K 2.9 Grams

 
2.     I lost said receipt on November 26, 2022 and that I exerted all
efforts to locate the same but I could not remember exactly where I
placed/left it 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
______________ in the City of ___________, Philippines.
 
 
                                                               MARIA LENNIE DAANOY
 Affiant
 
 
SUBSCRIBED AND SWORN to before me this _______________ in the
City of ____________ Philippines, affiant having exhibited to me his
community tax certificate with no. _______________  issued on
______________ at _____________.
 
Doc. No.____;
Page No.____;
Book No.____;
Series of 2022