Republic of the Philippines)
Province of Leyte )S.S.
Tacloban City)
x---------------x
AFFIDAVIT OF LOSS
I, NICOLE DAVOCOL, Filipino, of legal age, single and a resident of
Dist. 2 Poblacion, Dagami, Leyte, Philippines, after being duly sworn in
accordance with law, depose and state:
1. That I pawned my jewelries at Cebuana Lhuillier Pawnshop, Dagami,
Leyte, Philippines and was issued a Pawn Ticket with the following
descriptions:
Pawn Ticket No. : 62396NP000895
Amount : Php28,678.13
Date pawned : Oct 6, 2024
Descriptions : Necklace Gold curb 18k
2. That the said pawn ticket while in my possession was misplaced and
got lost;
3. That despite diligent search and efforts to locate the said pawn ticket, I
could not find the same such that I now believe that they are now lost
beyond recovery.
4. As such, I am executing this Affidavit of Loss to attest to the
truth of the foregoing facts.
IN WITNESS WHEREOF, I have hereunto set my hand this ____________
at Tacloban City, Leyte, Philippines.
NICOLE DAVOCOL
Affiant
SUBSCRIBED AND SWORN TO before me ______________ in Tacloban
City, Leyte, Philippines, affiant being personally known to me to be the same
person who executed the foregoing instrument.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2020.
