REPUBLIC OF THE PHILIPPINES ) City of Iloilo :

x-----------------------x AFFIDAVIT OF LOSS I, Roberta H. Capada , Filipino, of legal age, single, and a resident of 29 Mission Road, La Paz, Iloilo City, Philippines, after being duly sworn in accordance with law, depose and state: 1 That sometime on June 22, 2013, I pawned my one YG bracelet yellow gold 21k 6.90 grams modern amount of Php 12, 150 with R.D. Pawnshop, Inc. located at DR #4 Tinsay Bldg., J. De Leon St., Iloilo City , and for which I was issued Pawn Ticket No. 3659423 with Loan date of June 22, 2013 and a maturity date on July 22, 2013. 2 That sometime on July 1, 2013, my wallet that contains the said Pawn Ticket was misplaced and got lost. 3 That despite diligent search and efforts to locate the said wallet and pawn ticket, I could not find the same such that I now believe that they are now lost beyond recovery. 4 As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing facts and to enable me to secure a duplicate or substitute copy of ticket and/or redeem the above-described item which I pawned.. IN WITNESS WHEREOF, I have hereunto set my hand this July 20, 2013 Iloilo City, Philippines. Roberta H. Capada Affiant

SUBSCRIBED AND SWORN to before me this 22th day of February 2011,affiant having exhibited her Community Tax Certificate No. 4326 issued on 15 th day of January 2013 at Iloilo City, Philippines. Atty. Bermudo Johanna Marie B.

Doc. No. 21 Page No. 15 Book No. VII Series of 2013

Notary Public Until December 31, 2013 Roll of Attorney No. 36990 PTR No. 4020860/ January 5, 2013/ Iloilo City IBP No. 891079/ January 5, 2013/ Iloilo City MCLE Compliance No. III-0008465