Republic of the Philippines ) Alabel, Sarangani Province ) S S

AFFIDAVIT OF LOSS
I, GLEN CROMWELL AMBATALI GASCON, of legal age, married, Filipino and a resident of National Highway, Calabanit, Glan, Sarangani Province, after having duly sworn toin accordance with law, do hereby depose and say: That I am an owner-pledgor of ONE Ring with stone, ONE set Earring and Ring with pearl stone, ONE necklace with cross pendant and ONE pair of earing with des; That the abovementioned items were pawned at RD PAWNSHOP-Glan, Sarangani Province last 2012 for corresponding amount: Php6,500.00, Php5,600.00, Php8,000.00 and Php4,300.00 and I was thereby issued pawntickets nos. 2057555, 2057556, 2057557 and 2057558, respectively; That sometime on December, 2012, the abovementioned pawn tickets were inadvertently dropped while riding on a public vehicle to Alabel, Sarangani Province; That I exerted my best effort to locate the same but to no avail; That the aforesaid pawn tickets are now beyond recovery; I am executing this affidavit to attest to the foregoing facts. IN WITNESS WHEREOF, I have hereunto set my hand this _____day of _______________________ , 20 ____, in the Municipality of ___________, Province of _______________ , Philippines

GLEN CROMWELL AMBATALI GASCON Affiant SUBSCRIBED AND SWORN to before me in the Province of Sarangani, Municipality of _________, Philippines, this _____ day of ______________. Affiant having exhibited to me his Community Tax Certificate No. 33341123 issued on February 5, 2013 at Alabel, Sarangani Province.

Notary Public DOC. NO.______; PAGE NO.______; BOOK NO.______; Series of 2013