Republic of the Philippines )

Camiling Tarlac ) S.S.

AFFIDAVIT OF LOSS

I, FREDALYN GONZALES y TORRES, 34 years old, married, Filipino citizen,

and a resident of Barangay Quezon, Gerona, Tarlac, Philippines, after having been duly
sworn to in accordance with law, do hereby depose and state THAT:

1. On October 9 and October 21, 2015, I pawned some of my jewelries at the St.
Patrick Pawnshop located at Santa Ignacia, Tarlac and I was issued pawn
tickets with numbers 7035 and 6356;

2. After my transaction with the said pawnshop, I placed the said tickets inside
my wallet and went home;

3. Sometime in January 2016, while I was in Avenida, Manila, I was walking

towards the Isetan Mall, I noticed that my shoulder bag was opened. Right
away, I checked the contents of my bag and discovered that my wallet was
missing;

4. I tried to search for my missing wallet within the area but I found nothing. The
place was crowded and my effort to locate the said wallet containing the said
pawn tickets and other personal belongings turned utile; hence, I now
consider them lost and beyond recovery;

5. I am executing this Affidavit to attest to the truth of the foregoing statements

with the intent of renewing the pawn covered by such tickets even in the
absence of the said tickets and for whatever legal intents and purposes this
may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 10th day of

February, 2016 at Camiling, Tarlac, Philippines.

FREDALYN T. GONZALES
Affiant

SUBSCRIBED AND SWORN to before me on the date and place indicated

above. Affiant exhibited before me her Postal Identity Card with Number 4851913 valid
until June 30, 2017 issued by the Postal Administration of the Philippines.

Doc. No. _____; Page No. _____; Book No. _____; Series of 2016.