Republic of the Philippines )

Taal, Batangas ) S.S.

AFFIDAVIT OF LOSS

I, OLIVER LACORTE BENEDICTO, of legal age, Filipino, and resident of Brgy. Saimsim, Sta.
Teresita, Batangas, after being duly sworn according to law, hereby depose and state that:

1. On August 29, 2023, I pawned an 18k necklace to Cebuana Lhuilier.

2. As proof of the said transaction, I was issued Pawn Ticket No. 60847NP001718.
3. I place the said pawn ticket in the pocket of my jeans whenever I need to use the
same when transacting with Cebuana Lhuilier.

4. Unfortunately, however, last September 2023, I forgot to remove the said ticket
from my pocket when I arrived home and the same was washed along with my jeans in the
laundry.

5. As a result, the ticket was destroyed beyond repair.

6. The said pawn ticket has not been confiscated by any officer of the law or the
issuing office or agency due to the violation of any law, statute, order, rule or regulation.

7. I am executing this Affidavit to attest to the truth of the foregoing statements

and to request the issuance of a pawn ticket in lieu of the one which was destroyed.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this ____________________ at

Taal, Batangas.

OLIVER LACORTE BENEDICTO

Affiant

SUBSCRIBED AND SWORN to before me this ______________________, affiant

exhibited to me his/her Competent Evidence of Identity by way of Driver’s License No. N19-78-
015849 expiring on 03/10/2024.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2023. ATTY. MA. ANGELICA J. GUMAPAC
Notary Public
Until December 31, 2024
Roll of Attorneys No. 69996
PTR No. 32128227/01.25.23/ Taal, Batangas
IBP No. 309564/02.03.23/Makati City
MCLE Compliance No. VII-0013254/ 03.24.22