REPUBLIC OF THE PHILIPPINES )

QUEZON CITY ) S.S.

AFFIDAVIT OF LOSS

I, JOHANNA OJEDA, of legal age, Filipino citizen, with residence address

at No. 33 Betty Go Belmonte Unit D Palm Royale Townhomes Brgy. Mariana
New Manila, Quezon City, after having been duly sworn to in accordance with
law, hereby depose and state;

1. That I am the holder of a Pawn Tickets with Pawn Tickets Numbers

10221SG003005 and 10221SG008025 issued by Cebuana Lhuillier
Pawnshop owned by JASMINE N. ONG and more particularly
described as follows;

Pawn Ticket No. : 10221SG003005/10221SG008025

Description : 1 Ladys Ring w/ Brill 14k 3.1 grams
1Wedding Ring w/Brill 14k 4.7 grams 1pc
Amount : P 3,317.00 and P 5,659.00
Loan Date : October 21, 2019
Expiry Date : February 19, 2020

2. Said pawn tickets were usually kept in my drawer at my residence for

safe keeping;

3. However, due to inadvertence and/or oversight, I discovered that the

above-mentioned pawn tickets were missing and its whereabouts are
unknown;

4. I exerted diligent efforts to locate and look for the above-mentioned

pawn tickets in other places, but the same proved futile and to no
avail;

5. For all intents and purposes, I am now declaring the above-mentioned

pawn tickets lost and beyond recovery;

6. I execute this Affidavit to attest to the truth of the foregoing facts

based on my personal knowledge and for whatever legal purpose it
may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 29 th day of
November 2019 at Quezon City, Philippines.

JOHANNA OJEDA
Affiant

SUBSCRIBED AND SWORN to before me this 29 th day of November 2019 at

Quezon City, Philippines. Affiant exhibited to me her CTC/ID No.
_______________issued on ____________________ at ________________________.

Doc. No.: _____________ NOTARY PUBLIC

Page No.: _____________
Book No.: _____________
Series of 2019