Affidavit of Loss

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REPUBLIC OF THE PHILPPINES )

CITY OF GENERAL S A N T O S ) S.S.

AFFIDAVIT OF LOSS

I, __________________, of legal age, Filipino, married


with postal address at General Santos City, after having been
duly sworn to in accordance with law, do hereby depose and
say:

1. That sometime on ___________________ at about 8:00


o’clock in the evening, my wallet fell off from back
pocket without my knowledge;

2. That my wallet contains pertinent documents, to wit:

a) _________________
b) _________________

3. That said documents were lost and could no longer be


found despite diligent efforts to locate the same;

4. That I am executing this affidavit to attest to the


truth of the foregoing facts and for whatever
purpose this may legally serve.

IN WITNESS WHEREOF, I have hereunto set my hand this


____________ at General Santos City.

______________________
Affiant

SUBSCRIBED AND SWORN to before me this ________________


at General Santos City, Philippines.

Doc. No.__________;
Page No.__________;
Book No.__________;
Series of 2014.
REPUBLIC OF THE PHILPPINES )
CITY OF GENERAL S A N T O S ) S.S.
x-------------------------x

AFFIDAVIT OF LOSS

I, ALLAN G. LOPEZ, of legal age, Filipino, married with postal address at 1422
Recto-Sampaloc St., General Santos City, after having been duly sworn to in accordance
with law, do hereby depose and say:

1. That on May 3, 2006, I pawned one (1) bracelet with M. Lhuillier


Pawnshop, Pioneer Avenue Branch, General Santos City to secure a loan
of P2,000.00.
2. That the pawn ticket with No. 5466 issued to me was lost or misplaced
while in my possession;
3. That all efforts were exerted to locate said pawn ticket proved futile as the
same could no longer be found or located;
4. That I am executing this affidavit to attest to the truth of the foregoing
facts and for whatever purpose this may legally serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 9 th day of May,


2006 at General Santos City.

ALLAN G. LOPEZ
Affiant
CTC NO. 08716515
Issued on January 17, 2006
At General Santos City

SUBSCRIBED AND SWORN to before me this 9 th day of May, 2006 at General


Santos City, Philippines.

Doc. No. ____________;


Page No. ____________;
Book No. ____________;
Series of 2006.

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