REPUBLIC OF THE PHILIPPINES )

CITY OF TAGUIG )SS

AFFIDAVIT OF LOSS


I, ANGELITO Q. VALDEZ, Filipino, of legal age, and a resident of #95 Pulong
Kendi II, Sta. Ana, Taguig City after having been duly sworn in accordance
with law, hereby depose and say:

That , I am a hol der of a Soci al Securi t y Syst em
I dent i f i cat i on Card i ssued by Social Security System (SSS);

That I used to put the said identification card inside my wallet;

That sometime on July 30, 2014, when I arrived home from
work, I discovered that my wallet is missing where I used to put my
Social Security System Identification Card;

That diligent effort to locate the same had proved futile;

That I am executing this affidavit to attest to the truth of the
f oregoi ng f act s and t o request f or a repl acement of sai d SSS
I D card at Soci al Securi t y Syst em.

IN WITNESS WHEREOF , I have hereunto affixed my signature this ____day of
____________ 2014 at Taguig City, Philippines.



ANGELITO Q. VALDEZ
Affiant


SUBSCRIBED AND SWORN TO before me, a notary public this 26
th
day of
August 2014 at ______________. Affiant exhibiting to me his BIR Tax
Identification ID with no. 141913179 issued at BIR Taguig.



Doc. No. ______
Page No. ______ NOTARY PUBLIC
Book No. _____
Series of 2014.