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REPUBLIC OF THE PHILIPPINES PROVINCE OF ILOCOS SUR MUNICIPALITY OF SINAIT x - - - - - - - - - - - - x
S.S.
AFFIDAVIT
OF
LOSS
The undersigned, MARIBETH UNCIANO, of legal age, Filipino citizen, married and a resident of Brgy. Pug-os, Sinait, Ilocos Sur, after having been duly sworn to in accordance with law, hereby deposeth and sayeth; That I am the owner and pawner of an item described in the pawn ticket as: 1 gentlemen’s ring (10.8 grams) which I pawned at Cebuana Pawnshop, Sinait branch, and for which I was issued Pawnshop Ticket No. 26844 with maturity date on July 19, 2006 and expiry date on October 17, 2006; That the said pawnshop ticket issued to me was lost misplaced due to circumstances beyond my control, not of my liking fault or negligence; That I exerted all efforts to locate the same but to no avail and the said ticket is now beyond recovery; That I am executing this affidavit to attest the truth and correctness of the foregoing statements for all legal intents and purposes. FURTHER, affiant sayeth naught. EXECUTED THIS DATE, the 28th day of October, 2006 in the municipality of Sinait, Ilocos Sur, Philippines.
MARIBETH UNCIANO A f f i a n t
SUBSCRIBED AND SWORN to before me on _____________ in the municipality of Sinait, Ilocos Sur.
S.S.
AFFIDAVIT
OF
LOSS
The undersigned, MARIBETH UNCIANO, of legal age, Filipino citizen, married and a resident of Brgy. Pug-os, Sinait, Ilocos Sur, after having been duly sworn to in accordance with law, hereby deposeth and sayeth; That I am the owner and pawner of an item described in the pawn ticket as: 1 gentlemen’s ring (10.8 grams) which I pawned at Cebuana Pawnshop, Sinait branch, and for which I was issued Pawnshop Ticket No. 26844 with maturity date on July 19, 2006 and expiry date on October 17, 2006; That the said pawnshop ticket issued to me was lost misplaced due to circumstances beyond my control, not of my liking fault or negligence; That I exerted all efforts to locate the same but to no avail and the said ticket is now beyond recovery; That I am executing this affidavit to attest the truth and correctness of the foregoing statements for all legal intents and purposes. FURTHER, affiant sayeth naught. EXECUTED THIS DATE, the 28th day of October, 2006 in the municipality of Sinait, Ilocos Sur, Philippines.
MARIBETH UNCIANO A f f i a n t
SUBSCRIBED AND SWORN to before me on _____________ in the municipality of Sinait, Ilocos Sur.
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