REPUBLIC OF THE
CITY/MUNICIPALITY OF _____ ) S.S.
x-------------------------------------x
AFFIDAVIT OF LOSS
I, ___________________, of legal age, Filipino, single and a resident of _______________________________, after having been duly sworn to in accordance with law, depose and state THAT:
1. Sometime on ______________, I pawned my _________ with Tambunting Pawnshop located at _____________________ and for which I was issued Pawn Ticket/Receipt No. _________;
2. I kept the said pawn ticket in my wallet for safekeeping but unfortunately my wallet got lost;
3. Despite diligent search and efforts to locate the said wallet and pawn ticket, I could not find the same such that I believe that they are now lost beyond recovery;
4. As such, I am executing this affidavit to attest to the foregoing facts and to enable me to secure a duplicate or substitute copy of the ticket and/or redeem the above-described item which I pawned.
1. Sometime on ______________, I pawned my _________ with Tambunting Pawnshop located at _____________________ and for which I was issued Pawn Ticket/Receipt No. _________;
2. I kept the said pawn ticket in my wallet for safekeeping but unfortunately my wallet got lost;
3. Despite diligent search and efforts to locate the said wallet and pawn ticket, I could not find the same such that I believe that they are now lost beyond recovery;
4. As such, I am executing this affidavit to attest to the foregoing facts and to enable me to secure a duplicate or substitute copy of the ticket and/or redeem the above-described item which I pawned.
IN WITNESS WHEREOF, I have hereunto set my hand this ___________________ in ____________, Philippines .
____________________
Affiant
GSIS ID No. _____________
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SUBCRIBED AND SWORN TO before me this ___________________ in _________________, Philippines, affiant exhibiting to me his valid proof of identification.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2013.