REPUBLIC OF THE PHILIPPINES )

DASMARIÑAS CITY, CAVITE . . . . . . ) S.S.

AFFIDAVIT OF LOSS
I, GIZAH MAYE D. PALUBON, Filipino, of legal age and residing Blk 35 Lot 4 Ph 2
Winward Hills Subdivision, Dasmariñas City, Cavite, after being duly sworn to in accordance
with law, depose and state: That - -

1. I am the holder of a Professional Regulatory Commission (PRC) Identification

Card for Registered Social Worker with License No. 0022000

2. Unfortunately, on July 31, 2016, the said document was misplaced.

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 3rd of day of

August 2016 in Dasmariñas City, Cavite.

GIZAH MAYE D. PALUBON

Affiant

SUBSCRIBED AND SWORN to before me this 3rd of day of August 2016 in

Dasmariñas City, Cavite affiant exhibiting to me her PAG-IBIG ID WITH MID# 1211-2467-
0734.

Doc. No. ____;

Page No.____;
Book No. ____;
Series of 2016.
REPUBLIC OF THE PHILIPPINES )
DASMARINAS, CAVITE . . . . . . ) S.S.

AFFIDAVIT OF LOSS

I, LORNA L. ARCEO, Filipino, of legal age and residing at Blk. 12, Lot 14, Bgy.
Emmanuel I, Dasmarinas, Cavite, after being duly sworn to in accordance with law, depose and
state: That - -

1. I am a holder of a pawn ticket issued by M. Lhuillier-Bgy. Emmanuel Branch,

with no. 41096, covering my pledge of one pulceras with magnet;

2. Recently, I fouind out that the afore-said pawnticket was misplaced, lostn and/or
missing;

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 09th day of June
2009 in Dasmarinas, Cavite.

LORNA L. ARCEO
Affiant

SUBSCRIBED AND SWORN to before me this 09th day of June 2009 at Dasmarinas,
Cavite. Affaint exhibiting to me her Community Tax Cert. No. 09018673 issued on 07.13.09 at
Dasma., Cavite.

Doc. No. 140;

Page No. 28; Notary Public
Book No. 107;
Series of 2009.