Republic of the Philippines )

Camiling, Tarlac ) S.S.

AFFIDAVIT OF NO EARNINGS

I, CRISTITA F. MADARANG, 60 years old, Filipino

citizen, married and a resident of Barangay San Vicente, Santa
Ignacia, Tarlac, Philippines, after having been duly sworn to in
accordance with law, do hereby depose and state THAT:

1. I became a self-employed member of the Social

Security System (SSS) of the Philippines when I was
engaged in farming;

2. However, starting October 1, 2016, due to health

reasons and old age, I ceased to work as a farmer and
did not engage in any gainful occupation up to present;

3. I am executing this Affidavit in support of my

Retirement Claim from the SSS and to attest to the
truth of the foregoing statements and for all legal
intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my

signature this 1st day of March, 2017 at Camiling, Tarlac,
Philippines.

CRISTITA F. MADARANG
Affiant

SUBSCRIBED AND SWORN to before me on the date

and place indicated above. Affiant exhibited before me his
Senior Citizen ID Card with Control No. 05-07530 issued by the
OSCA, Santa Ignacia, Tarlac.

Doc No._______;
Page No.______;
Book No.______;
Series of 2017.