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Affidavit of Lost Receipt

Mary Joy F. Saluta executed an affidavit of loss stating that she had pawned 1.00 YG earrings weighing 1.05 grams at Mlhuiller on April 5, 2021 for P5,600 but has since lost the original receipt (OR) for the transaction. Despite her efforts, she was unable to find or recover the lost OR. She signed the affidavit on October 7, 2021 in Dipolog City, Philippines to attest to the fact of losing the aforementioned receipt. The affidavit was also signed and sworn to by an assistant on the same date.

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675 views1 page

Affidavit of Lost Receipt

Mary Joy F. Saluta executed an affidavit of loss stating that she had pawned 1.00 YG earrings weighing 1.05 grams at Mlhuiller on April 5, 2021 for P5,600 but has since lost the original receipt (OR) for the transaction. Despite her efforts, she was unable to find or recover the lost OR. She signed the affidavit on October 7, 2021 in Dipolog City, Philippines to attest to the fact of losing the aforementioned receipt. The affidavit was also signed and sworn to by an assistant on the same date.

Uploaded by

JRMSU Finance Office
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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REPUBLIC OF THE PHILIPPINES)

CITY OF DIPOLOG )S.S


x-------------------------------------------/

AFFIDAVIT OF LOSS

KNOW ALL MEN BY THESE PRESENTS:

I, MARY JOY F. SALUTA, Filipino, of legal age, married, and a resident of Sepac, Sapangdalaga,
Misamis Occidental, after having sworn to in accordance with law, depose and say that:

I had been in possession of OR number 0532-2021-00149 issued by Mlhuiller as proof of my pawned


earrings bearing the description 1.00 YG Earring DEF by 105 2.40 G;

That the same earrings was pawned last April 5, 2021 with an amount of P5, 600;

That the above-mentioned OR was lost;

Despite earnest efforts exerted by me, the same could no longer be found nor recovered;

I am executing this affidavit in good faith and in accordance with law, to attest to the fact of
the loss of aforementioned OR.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 7th day of October, 2021 at
Dipolog City, Philippines.

MARY JOY F. SALUTA


_______________________
Affiant

SUBSCRIBED, SIGNED, AND SWORN TO in my personal presence, this 7 th day of October,


2021, at Dipolog City, Philippines, affiant presenting her competent proof of identity, the particulars
of which are above-cited, and who avowed under penalty of law to the whole truth of the contents of
the instrument or document, which she executed freely and voluntarily.

Doc. No. _____;


Page No. _____;
Book No._____;
Series of 2021.

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