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Affidavit of Loss

Carolyn B. Alod pawned a lady's ring and necklace at Cebuana Lhuiller in August 2021 but has since lost the pawn tickets. She intends to pay back the loans to retrieve the items but cannot locate the tickets. She swears in an affidavit that the tickets were lost and have not been given to anyone else. She executed this affidavit to attest to the truth of her statements regarding the lost pawn tickets.

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Jules Derick
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205 views1 page

Affidavit of Loss

Carolyn B. Alod pawned a lady's ring and necklace at Cebuana Lhuiller in August 2021 but has since lost the pawn tickets. She intends to pay back the loans to retrieve the items but cannot locate the tickets. She swears in an affidavit that the tickets were lost and have not been given to anyone else. She executed this affidavit to attest to the truth of her statements regarding the lost pawn tickets.

Uploaded by

Jules Derick
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines )

DONE: CITY OF BAGUIO ) SS.

AFFIDAVIT OF LOSS

I, CAROLYN B. ALOD, of legal age, Filipino Citizen with residence and postal address
at Tinongdan, Itogon, Benguet, Philippines, after having been duly sworn to in accordance
with law do hereby depose and state that:

1. On August 3, 2021 I pawned my lady’s ring at Cebuana Lhuiller, Lakandula


Branch, Baguio City and I was issued a pawn receipt and particularly described,
to wit:

Pawnticket No. : 20605sg037341


Loan Date : August 3, 2021
Maturity Date : September 3, 2021
Expiry Date : December 3, 2021
Amount : P11,685.00
Description : Lady’s Ring w/ flower design
Grams : 4.1 21k

2. On August 6, 2021 I pawned my necklace at Cebuana Lhuiller, Lakandula


Branch, Baguio City and I was issued a pawn receipt and particularly described,
to wit:

Pawnticket No. : 20605sg037419


Loan Date : August 6, 2021
Maturity Date : September 6, 2021
Expiry Date : December 6, 2021
Amount : P13,110.00
Description : Necklace w/ pendant w/ braided chain
Grams : 4.6 21k

3. I intend to pay the aforesaid loaned inorder to retrieve my pawned necklace and
lady’s ring; however, I could not find the pawnshop tickets. I do not know how I
lost it, maybe I misplaced it or thrown it away thinking that it is a trash. Despite
my diligent efforts to locate the said tickets it could no longer be found, hence,
considered forever lost;

4. The said tickets has not been given nor pledged to anyone for any purpose
whatsoever, nor were taken or confiscated by the authorities for any violation of
any law or regulations;

5. I am executing this affidavit to attest to the truth of my foregoing statements and


for all legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 28th day of December,
2021, at Baguio City, Philippines.

CAROLYN B. ALOD
Affiant
PhilHealth ID No. 04-025147770-3

SUBSCRIBED AND SWORN TO before me this 28th day of December, 2021 at Baguio
City, Philippines. Affiant personally appeared before me and to be the same person who
executed this instrument voluntarily.

Doc. No. 76;


Page No. 16;
Book No. 51;
Series of 2021.

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