Republic of the Philippines)
City of Bacolod)
x--------------------------------x
AFFIDAVIT OF LOSS
I, ____________________, of legal age, Filipino, married, and a resident of
_______________________, Philippines, after having been sworn to in
accordance with law, depose and state:
1. That I am a member of the Social Security System and was issued an ID
with No. ______________
2. That I used to place my SSS ID together with other important documents
inside my wallet for safekeeping;
3. That recently, when I looked for my SSS ID, the same could not be
found and must have been misplaced. Despite diligent search and efforts
to locate the said ID, I could not find it such that I believe that it is now
lost beyond recovery;
4. As such, I am executing this Affidavit of Loss to attest to the truth of the
foregoing and for whatever legal purposes that this affidavit may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 7th day of
December 2017 at Bacolod City, Philippines.
____________________________
Affiant
SUBSCRIBED AND SWORN to before me, this 7th day of December 2017,
by _______________________ who exhibited to me his
________________________________ which is valid until May 14, 2022.
Doc. No. ______;
Page No. ______;
Book No. ______;
Series of 2017.