Republic of the Philippines )

Province of Northern Samar ) S.S.

Municipality of Catarman )

AFFIDAVIT OF LOSS

I, EVELYN SABILAO, of legal age, Filipino citizen, and resident

of Brgy. Bobon, Northern Samar, after having been duly sworn in
accordance with law, hereby depose and state that:

1. I was issued a Pawnticket No.603235G020200 with item

description Earring Pair Creolla, 1.8 grms. and Pawnticket
No.60323Sg020201 with item description Earring Pair Creolla
1.4 grms. by Cebuana Lhuillier, Catarman branch, Catarman,
Northern Samar;

2. However, Sometime in April 2021, the said pawn tickets were

lost while in my possession;

3. After I discovered that the said pawn tickets were lost, I tried
and exerted considerable efforts to recover the same but the
same was of no avail;

4. I execute this affidavit to attest the truth and veracity of the

foregoing facts and circumstances and for any legal intents
and purposes this may best serve.

IN WITNESS WHEREOF, I have hereunto set my hand and

affixed my signature this 28th day of May, 2021 in Catarman,
Northern Samar.

EVELYN SABILAO
Affiant

SUBSCRIBED AND SWORN to before me this 28th day of May,

2021 at Catarman, Northern Samar.

Doc. No. __________;

Page No. __________;
Book No. __________;
Series of 2021;