Affidavit of Loss - PAWNSHOP

Download as doc, pdf, or txt
Download as doc, pdf, or txt
You are on page 1of 1

REPUBLIC OF THE PHILIPPINES)

PROVINCE OF LAGUNA)
MUNICIPALITY OF CALAUAN ) S. S.

AFFIDAVIT OF LOSS

I, JOEL BARRACA HALILI, Filipino, of legal age, and resident and with
postal address at Brgy. Balayhangin, Calauan, Laguna, after having duly sworn to in
accordance with law, do hereby depose and state:

1. That I have been issued a receipt by RAQUEL PAWNSHOP – Calauan Branch


with details of:
Pawn Ticket: 020704
Date Loan Granted: July 4, 2019
Expiration date: November 1, 2019
Description: Principal:
1G RING 1g heart w/scratch 2200/1200
1G POFE 1g channel w/scratch 2200/2200

2. That sometime in the month of September 2019 I discovered that my receipt is


missing;

3. That notwithstanding thorough and diligent efforts that I have exerted to locate
my receipt, I could not find it and in all probability, it can no longer be recovered;

4. That I executed this Affidavit to attest to the fact of loss for whatever other legal
purpose this may serve;

IN WITNESS WHEREOF, I have hereunto affixed my signature this 23rd day


of October 2019 at Calauan, Laguna.

JOEL BARRACA HALILI


Affiant
Driver’s License: D14-98-085811

SUBSCRIBED AND SWORN to before me a Notary Public for the Municipality of


Calauan, Bay, Los Banos and in the City of Calamba Laguna with office address at 2/F,
Villaran Building, Alvela St., Brgy. Kanluran Calauan Laguna, this 23rd day of October
2019 personally appeared the above named affiant showing to me her ID and avows
under penalty of law to the whole truth of the contents thereof.

ATTY. ALDRIN P. ALIMBUYOG


NOTARY PUBLIC
2F, Villaran Building, Alvela St. Brgy. Kanluran,
Calauan,Laguna
Roll. No. 73376
IBP. 088585/LAGUNA
Doc. No. _______ PTR No. 7391498 /07-09-19 / Calauan, Laguna
Page No. _______ MCLE: Newly admitted to the BAR
Book No._______ Email Address; [email protected]
Series of 2019 Cellular Phone No. 09565207359

You might also like