REPUBLIC OF THE PHILIPPINES)

IMUS, CAVITE ) S.S.

AFFIDAVIT OF LOSS
I, Agnes Garganera Bayley, of legal age, married, Filipino citizen, and presently
residing at Block 33 Lot 7 Legian 2C Carsadang Bago 1, Imus, Cavite, Philippines after
having been duly sworn to in accordance with the law, hereby depose and state:

1. That I pawned my OPPO A31 Cellphone at FLM Pawnshop located at Imus

Public Market and was issued a Pawn Ticket with the following description:

PAWN TICKET NO.: 8696

Loan Value: Php. 1,520.00
Date Loan: September 8, 2023

2. That I used to put the said receipt in my wallet, sometime on October

20,2023, the said receipt was misplaced inside our house and considered it
was lost;

3. Efforts were exerted to locate said receipt but in spite of diligent search it
could not be found and the same is now beyond recovery;

4. 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 that I pawned.

IN WITNESS WHEREOF, have hereunto set my hand this 23 rd day of October 2023 in
Imus City, Cavite, Philippines.

________________________
Agnes Garganera Bayley
affiant

SUBSCRIBED AND SWORN to before me this 23 rd of October 2023 at the City of Imus,
Cavite, by the affiant who exhibited to me her competent evidence of identity TIN with
no. 705-933-907-00000, as attached and she is the same person who personally signed
before me the foregoing affidavit and acknowledged that she executed the same.

Doc. No. _____;

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