REPUBLIC OF THE PHILIPPINES )

PROVINCE OF CAVITE ) S.S.s

AFFIDAVIT OF LOSS

I, JOHN AUGUSTUS LUBIO, of legal age, Filipino, with address at Brgy.

Marahan 2, Alfonso, Cavite after having been sworn to in accordance with law,
hereby depose and state, that:

1. I have pawned my pair of earrings,18k, 1 .80gms with Cebuana

Lhuillier in Alfonso Cavite and was issued a Pawn Ticket with
no.30401NP001072;

2. However, upon checking my files, I found out just recently that the said
Pawn Ticket was misplaced and cannot be found;

3. Despite diligent search and efforts to recover the said Pawn Ticket the
same can no longer be located;

4. I am executing this affidavit not for any unlawful purpose but for any
valid and legal purpose only.

IN TRUTH WHEREOF, I have hereunto affixed my signature this 27 th day of

March, 2023 at Alfonso, Cavite.

JOHN AUGUSTUS LUBIO

Affiant

SUBSCRIBED AND SWORN to before me this 27th day of March, 2023 at

Alfonso, Cavite. Affiant exhibiting to me her VIN:1410-0427B-H2788JCL10000.

WITNESS MY HAND AND SEAL.

Doc. No. 489; ATTY. ENRIQUE G. BAUTISTA JR.

NOTARY PUBLIC FOR THE PROVINCE OF CAVITE
Page No. 99; COMMISSION EXPIRES ON DECEMBER 31, 2024
Book No. 5 ; ROLL OF ATTORNEY’S NO.52758
PTR NO. 5842958/ISSUED ON 01/9/2023 AT ALFONSO CAVITE
Series of 2023 IBP LIFETIME No. 031665/01/30/2018
MCLE COMPLIANCE VII-0012699 VALID UNTIL APRIL 14, 2025
.