REPUBLIC OF THE PHILIPPINES)

Province of Guimaras ) S.S

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

AFFIDAVIT OF LOSS
I, REYAN E. FERRER, of legal age, Filipino, single and a resident of Brgy. San Roque,
Buenavista, Guimaras, Philippines, after having been duly sworn to in accordance with law,
hereby voluntarily depose and state;

1. That I pawned my jewelries at RD Pawnshop, Buenavista Guimaras Branch and was

issued a Pawn Ticket with the following description;

Pawn Ticket No.: 496-30423075

Amount: P2,760.00
Date pawned: October 18, 2023
Description: 01 YG Earrings pr
Stnd cross dsdf 18k
0.4 grams

01 YG Necklace foxtail
w/ span med pdt dsdf 18k
0.7 grams

2. I used to keep the said Official Receipt on my personal belongings at home;

3. That despite diligent search and efforts to locate the said Pawn Ticket, the same could
no longer be found from any of my belongings, such that I believe that now it is lost
beyond my recovery;

4. That I shall assume any responsibility or liability if in any event the said Pawn Ticket
was used with or without my knowledge for whatever illicit transactions;

5. That I am executing this Affidavit to attest to the truth of the foregoing statements and
for all legal intents and purposes it may serve.

IN WITNESS WHEREOF, I hereunto affixed my signature this ___ day of

__________, 2024 at the ______________, Philippines.

REYAN E. FERRER
Affiant
ID NO.:_________

SUBSCRIBED AND TO SWORN to before me on the date and place indicated

above. Affiant exhibited to me his/her _______________________ as competent proof of
identity.
 Notary Public
Doc. No.__;
Page No.__;
Book No.__;
Series of 2024.