REPUBLIC OF THE
PHILIPPINES)
CITY OF DUMAGUETE) S.S.
AFFIDAVIT OF LOSS
I, MARIA GEMMA AWID, of legal age, Filipino, married and a resident of Combado,
Bacong, Negros Oriental, after having been sworn to in accordance with law hereby
depose and say:
1. That I am the owner/holder of a CEBUANA LHULLIER PAWNSHOP RECEIPT
issued by CEBUANA LHULLIER PAWNSHOP, CLH-BACONG of a pawned 1pc
18k 1.9 grams wedding ring with Pawn Ticket No. 61775np000734;
2. That due to inadvertence said CEBUANA LHULLIER PAWNSHOP RECEIPT
was misplace causing for its loss;
3. That despite diligent efforts to locate the same, it coud no longer be found;
4. That is considered lost for all intents and purposes;
5. That I am executing this Affidavit to attest to the truthfulness of the foregoing
statements and for whatever legal purposes it may serve.
IN WITNESS WHEREOF, I hereby affixed my signature/s this day of
___________________ in Dumaguete City, Philippines.
MARIA GEMMA AWID
Affiant
SUBCRIBED AND SWORN TO before me this ___________________ in
_________________, Philippines, affiant/s exhibiting to me her competent proof of
identity.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2023.