REPUBLIC OF THE PHILIPPINES)

CITY OF MANILA ) S.S.

AFFIDAVIT OF LOSS

I, ANTONITH JANE UDAS of legal age, Filipino, single and a resident address at 2088
E Smith Brgy. 743, San Andres, Malate Manila, Philippines. After having been duly sworn to in
accordance with law, do hereby depose and say;

That I am the holder of a GOODLUCK PAWNSHOP & JEWELLER CORP.

RECEIPT with the following details below:

PT NUMBER : 18595
LOANDATE : May 21, 2022
AMOUNT : 2,000
DESCRIPTION : REALME C25 / 8666121037062292

That on May 23, 2022. While I was walking on a San Andres Street, Malate Manila.
Unfortunately, that above-mentioned GOODLUCK PAWNSHOP & JEWELLER CORP.
RECEIPT was lost. Probably, It fell down.

That the said GOODLUCK PAWNSHOP & JEWELLER CORP. RECEIPT was
lost/misplaced.

That I could no longer found the same, such that I believed that it is now lost beyond
recovery.

That I am executing this affidavit of loss to attest the truth of the foregoing facts and
primarily to receive my mortgage phone of the GOODLUCK PAWNSHOP & JEWELLER
CORP. RECEIPT.

IN WITNESS WHEREOF, I have affixed my signature this 25 th day of May 2022 at City
of Manila, Philippines.

ANTONITH JANE UDAS

Affiant

SUBSCRIBE AND SWORN TO before me this 25 th day of May 2022 at City Of Manila,
Philippines, affiant exhibiting to me her ______________________ with No.
________________ issued on ___________________ issued at _____________________.

Doc No.______
Page No.______
Book No.______
Series of 2022