AFFIDAVIT OF LOSS

I, DANICKA MISHEIL FAYE P. MACARAEG, of legal age, Filipino citizen,

and resident of Santiago City, Philippines, after being duly sworn in accordance with
law, hereby depose and state under oath:

1. That I am the lawful holder of a pawn receipt bearing with a pawn ticket no. 7518
from Tambunting Pawnshop;

2. That the said receipt was in my possession and custody, and I have exercised due
care and diligence to keep it safe and secure;

3. That on my way home from school on October 16, 2023, when I’m about to pay
my fare, I noticed that my wallet was already lost inside my bag to which said
receipt were kept including my other important documents;

4. That I have made a diligent search and inquiry to locate the lost receipt but to no
avail. It is irretrievably lost and cannot be recovered;

5. That the loss of the said receipt was not due to any negligence, willful act, or
omission on my part;

6. That I am executing this Affidavit of Loss to attest to the truth of the foregoing
facts and for the purpose of applying for the issuance of a new receipt.

IN WITNESS WHEREOF, I have hereunto set my hand this 18 th day of

October, 2023, in the City of Santiago, Philippines.

DANICKA MISHEIL FAYE P. MACARAEG

Affiant

SUBSCRIBED AND SWORN to before me this 18th of October, 2023, in the

City of Santiago, Philippines, affiant exhibiting competent evidence of identity through
National ID with ID 5846-8067-2185-7024, issued on September 20, 2022.

WITNESS MY HAND AND SEAL.

Notary Public

Doc. No. _____;

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