REPUBLIC OF THE 

PHILIPPINES)
Quezon City) S.S.
x-------------------------------------x
  

AFFIDAVIT OF LOSS OF PAWNTICKET

I, TERESITA RODOLFO PERVERA, of legal age, Filipino, with a resident of 9 RD 2

PROJ 6 QUEZON CITY, after having been duly sworn to in accordance with law, depose and
state THAT:

1. That I am the holder/owner of a PAWNTICKET issued by CEBUANA LHUILLIER

which is particularly described below;

 PT NO. 61560SG003719
 LADY’S RING
 KARAT: 18K
 GRAMS: 1.8
 AMOUNT: 3,600
 LOAN DATE: March 24, 2023
 EXPIRY DATE: July 24, 2023

2. Despite diligent search and efforts to locate the said pawn ticket, I could not find the
same such that I believe that it is now lost beyond recovery; 

3. As such, I am executing this affidavit to attest to the foregoing facts and to enable me to

secure a duplicate or substitute copy of the ticket and/or redeem the above-described item
which I pawned.

IN WITNESS WHEREOF, I have hereunto set my hand this June 23rd, 2023, in Quezon
City, Philippines.

TERESITA RODOLFO
PERVERA
Affiant

SUBCRIBED AND SWORN TO before me this June 23rd, 2023, in Quezon City, Philippines,
affiant exhibiting to me his valid proof of identification.

Doc. No. _____;

Page No. ____;
Book No. _____;
Series of 2023