REPUBLIC OF THE PHILIPPINES )
DASMARIÑAS, CAVITE . . . . . . ) S.S.
AFFIDAVIT OF LOSS
I, CECILLE G. PANTI, Filipino, of legal age and residing Blk A5 Lot 7 Brgy. San Luis
2, Area E, Dasmariñas City, Cavite, after being duly sworn to in accordance with law, depose
and state: That - -
1. I am the holder of the pawn ticket with descriptions to wit:
LOSS- RECEIPT-
CEBUANA LHUILIER CLH DBB E BRANCH
PAWNTICKET NO.: 30405SG027424
LOAN DATE: 10-19-2018
MATURITY: 11-19-2018
PRINCIPAL AMT: PHP 5,900.00
DESC: LADY’S RING
EXPIRY DATE: 2-18-2019
2. Recently, the above-mentioned pawn ticket was lost in my possession.
3. I exerted sincere efforts to locate and to recover the same but all my efforts proved
futile;
4. I am executing this affidavit to attest to the truth and veracity of the foregoing and
for whatever legal purpose the same may serve;
IN WITNESS WHEREOF, I have hereunto affixed my signature this 7th of day of
January 2019 in Dasmariñas City, Cavite.
CECILLE G. PANTI
Affiant
SUBSCRIBED AND SWORN to before me this 7th of day of January 2019 in
Dasmariñas City, Cavite affiant exhibiting to me her voters ID #VIN-2106-0824A-
H1180CGP20000
Doc. No. ___;
Page No.____;
Book No. ____;
Series of 2019