REPUBLIC OF THE PHILIPPINES)

CITY OF GENERAL SANTOS ) S.S.

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AFFIDAVIT OF LOSS

I, RANIEL CANETE, Filipino citizen, of legal age, married, and a

resident of Purok Greenville, Brgy.Calumpang, General Santos City, after having
been duly sworn to in accordance with law, hereby depose and say:

1. That I pawned one (1) NECKLACE WITH PENDANT 18K, 2.9 grams
with Pawnshop Ticket No. 60166SG008460 issued by CEBUANA
LHUILLIER located at Calumpang, General Santos City;

2. That said CEBUANA LHUILLIER Pawnshop issued Pawnshop

Ticket No. 60166SG008460 was lost/misplaced by me and despite
my diligent search for it, the same could not be found anymore, hence
it may now be considered lost for all legal intents and purposes;

3. That I execute this affidavit to attest under oath the truth of all the
foregoing facts and in compliance with the procedural requirements of
Cebuana Lhuillier Pawnshop located at Calumpang, General Santos
City, and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 1st of

July, 2017 at General Santos City.

RANIEL CANETE
Affiant
DL No. L04-13-009257/LTO

SUBSCRIBED AND SWORN to before me this 1st of July, 2017 at

General Santos City, Philippines.

Doc. No. _____;

Page No. _____;
Book No. LXVIII;
Series of 2017.