REPUBLIC OF THE PHILIPPINES)

ILOILO CITY ) S.S.

AFFIDAVIT OF LOSS

I, AIDA T. TERANIA, of legal age, Filipino, single and a resident of Brgy. Bitas,
Tigbauan, Iloilo, after having duly sworn to in accordance with law, depose and state
that;

That I am the owner of a Cebuana Lhuillier receipt, issued by Cebuana Lhuillier

Tigbauan Branch, Tigbauan, Iloilo, Philippines;

That while looking for my files, I discovered that my Cebuana Lhuillier receipt
was lost and particularly described as:

Loan Date: May 22, 2023

Maturity Date: June 21, 2023
Pawnticket #: 41014sg033234
Item Description: Earring pair
Amount: Php 8,000.00

That upon discovery, I immediately looked for the same, in all possible places
where I could have kept it but I failed to retrieve the said Cebuana Lhuillier receipt;

That I exerted diligent efforts to look for the above-mentioned Cebuana Lhuillier
receipt, however to no avail, hence, such is now considered lost for all purposes;

That this affidavit is made and executed by me in order to attest to the truth of
the foregoing statements to prove the loss of the above-mentioned receipt and for
whatever legal purpose it may serve;

IN WITNESS WHEREOF, I have hereunto affixed my signature this

________________ in Tigbauan, Iloilo, Philippines.

AIDA T. TERANIA
Affiant
Brgy. ID: 013-BITAS-001

SUBSCRIBED AND SWORN TO before me this _____________ in Iloilo City,

Philippines, affiant exhibiting to me her competent evidence of identity.

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