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REPUBLIC OF THE PHILIPPINES)

QUEZON CITY ) S.S.


METRO MANILA )

AFFIDAVIT OF LOSS

I, MILDRED D. MARTINEZ, of legal age, Filipino, married, with residence


and postal address at Silvertowne II, 299 Malagasang I-E, Imus, Cavite,
Philippines, after having been duly sworn to in accordance with law, depose
and say:

1. That on 19 February 2007, I pawned my necklace with image


pendant to Cebuana LhuiIler Pawnshop, with Pawn Ticket No. 7428;

2. That sometime on the second week of June 2007, above-


mentioned Pawn Ticket No. 7428 was lost/misplaced in my above-stated
address without fault and negligence on my part;

3. That despite diligent efforts on my part to recover and/or


retrieve said Pawn Ticket but all to no avail for the same was deemed totally
lost and beyond recovery;

4. That I am executing this Affidavit to attest the truth of the


foregoing facts;

IN WITNESS WHEREOF, I have hereunto set my hand this 22 nd day of June


2007 at Quezon City, Metro Manila, Philippines.

MILDRED D. MARTINEZ
Affiant

JURAT

SUBSCRIBED AND SWORN to before me this 22 nd day of June 2007 at


Quezon City, Metro Manila, Philippines, affiant exhibited to me her Company
Identification Card No. 006 (Vital Staffing Multinational, Inc.).

Doc. No. 161; ERLINDA B. FERRER

Page No. 34; Notary Public


Book No. XVIII; Until December 31, 2008
Series of 2007. PTR NO. A-8451858/1-2-2007/Q.C.