REPUBLIC OF THE PHILIPPINES)

CITY OF MANILA ) S.S.

AFFIDAVIT OF LOSS

I, RALPH LORINE TAMAYO LAUDET, of legal age, Filipino, single and a resident
address at 142 L. Lupa St. May – Pajo Caloocan City, Philippines. After having been duly sworn
to in accordance with law, do hereby depose and say;

That I am the holder of a AHENSYA PAPER with the following details below:

TICKET NUMBER : 17541

DATE OF PAWN : October 13, 2023
EXPIRY DATE : February 13, 2023
AMOUNT : 25,000
DESCRIPTION : 1 – Bracelet and 1 - Chain

That on October 17, 2023. While I was walking on a San Andres Street, Malate Manila.
Unfortunately, that above-mentioned AHENSYA PAPER was lost. Probably, It fell down.

That the said AHENSYA PAPER 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 AHENSYA PAPER

IN WITNESS WHEREOF, I have affixed my signature this 20 th day of October 2023 at

City of Manila, Philippines.

RALPH LORINE TAMAYO

LAUDET
Affiant

SUBSCRIBE AND SWORN TO before me this 20 th day of October 2023 at City Of

Manila, Philippines, affiant exhibiting to me his National ID with No. 5406-8074-5394-7148
issued at Robinson Manila, Philippines

Doc No.______
Page No.______
Book No.______
Series of 2023