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Republic of the Philippines Province of Camarines Norte Municipality of DAET

) ) ) S.S.

AFFIDAVIT OF LOSS I, RONALD MURILLO, of legal age, Filipino citizen and with postal address at Capt. Abao Street, Brgy. 1, Daet, Camarines Norte, after having been duly sworn to in accordance with law, hereby depose and say: 1. That I am the owner of a certain television set, 21 Sharp model which I pledged at R.G. Pawnshop. Daet, Camarines Norte last December 21,2005; 2. That I was issued the corresponding pawnshop ticket for the same; 3. That the following day, my wallet containing such pawnshop ticket, among others got lost and despite diligent and earnest effort, the same proved futile; 4. That I have not entrusted said pawnshop ticket to any person or entity for whatever purpose/s; and 5. That I am executing this sworn statement to attest to the truthfulness of all the foregoing and for purposes of redeeming said pledged item just mentioned. In witness whereof, I have hereunto set my hand this 6th day of March 2006 at Daet, Camarines Norte.

RONALD MURILLO Affiant Subscribed and sworn to before me the day, year and place abovewritten. Doc. No.____ Page No.____ Book No. X Series of 2006

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