REPUBLIC OF THE PHILIPPINES )
MUNICIPALITY OF IBA ) S.S.
PROVINCE OF ZAMBALES )
AFFIDAVIT OF NO EARNINGS
I, EPIFANIO MONTEVIRGEN MONSALUD, Filipino, of legal age,
married and with residence and postal address at Barangay Zone 1,
Iba, Zambales being first duly sworn in accordance with law, depose
and state that:
1. I am a Self-employed Social Security System member with
SSS number 02-0445991-0;
2. I have been paying my dues since I was a member;
3. That I have been employed at Integrated Services Inc. at
Subic, Zambales.
4. That since December 31, 2012, I have no earnings from self-
employment;
5. I am executing this affidavit to attest to the truth and veracity
of the foregoing facts and for whatever legal purpose it may
serve.
EPIFANIO MONTEVIRGEN MONSALUD
Affiant
SUBSCRIBED AND SWORN to before me, a Notary Public for the
Province of Zambales, this ______________, affiants exhibiting to me his
Senior Citizen ID No. 4892 known to me to be the same person who
executed this affidavit.
Doc. No. ____; ATTY. DOMINGO B. DIVIVA V
Page No. ____; NOTARY PUBLIC
Book No. IV ; Until December 31, 2015
Series of 2015. Roll No. 60891
PTR No. Z-7195546
IBP No. 978586 Zambales
2nd Floor G-104 Brgy.Palanginan
Iba, Zambales
