AFFIDAVIT OF LOSS

I, AIZA CAGAMPANG BUSLON, of legal age, Filipino citizen, and resident of 9 Madrid St., Ciudad
Grande, Rosario, Pasig City, Philippines, after being duly sworn in accordance with law, hereby depose
and state under oath:

1.That I am the lawful owner/holder of Pawnticket issued by Cebuanna Lhuillier with the following
details below;
a. Pawn Ticket No. 10902NP001756
b. Item : Necklace with Pendant Gold
c. Karat and Grams : 18k / 1.30 grams
d. Principal Amount : Php3, 412.50
e. Loan Date : November 17, 2023
f. Expiry Date : March 18, 2024

2. That the lost item/document was in my possession and custody, and I have exercised due care and
diligence to keep it safe and secure.

3. That I have made a diligent search and inquiry to locate the lost item/document but to no avail. It is
irretrievably lost and cannot be recovered.

5. That I am executing this Affidavit of Loss to attest to the truth of the foregoing facts.

IN WITNESS WHEREOF, I have hereunto set my hand this 17 th day of December 2023 in Pasig
City, Philippines.

AIZA CAGAMPANG BUSLON

Affiant

SUBSCRIBED AND SWORN to before me this 17th day of December 2023, in Pasig City,
Philippines, affiant exhibiting competent evidence of identity through Postal ID with No PRN
E30190349389.

WITNESS MY HAND AND SEAL.

Doc. No. _____; Notary Public

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