Republic of the Philippines)

City of _____________ ) S.S.

x----------------------------------------x

AFFIDAVIT OF LOSS

I, NORALIE G. BAÑARES, of legal age, Filipino, and a resident of

Block 143, Lot 16, Huertas St., Central Bicutan, Taguig City, after having
sworn to in accordance with law, hereby deposes and states that:

1. I pawned jewelries in Cebuana Lhuillier and I was issued Pawn

Ticket No. 60961SG009242 and Pawn Ticket No. 60961SG008832;

2. I will now redeem my jewelries, however, the Pawn Ticket No.

60961SG009242 and Pawn Ticket No. 60961SG008832 were lost.

3. After diligent search and efforts to locate the pawn tickets, they can
longer be found and thus considered lost.

4. I am executing this affidavit to attest to the truth of the foregoing.

AFFIANT FURTHER SAYETH NAUGHT.

NORALIE G. BAÑARES
Affiant

SUBSCRIBED AND SWORN to before me this ___ day of December

at _____________, Affiant personally appearing before me exhibiting his
__________________ ID, a competent proof of her identity.

Doc. No. ____;

Page No, ____;
Book No. ____;
Series of 2022.