Republic of the Philippines )

Province of Davao del Norte)s.s

Municipality of Kapalong )
x-----------------------------------------x

AFFIDAVIT
I, _________________________, of legal age, Filipino, married and a resident
of Magatos, Asuncion, Davao del Norte, after having been sworn to in
accordance with law, hereby depose and say that:

1. I am the same person whose personal circumstances are described in the

preceding paragraph;

2. I am a bonafide member of the Social Security System (SSS) since 2010;

3. I was employed at T’NALAK Labor Services Cooperative from February

until the present;

4. I have an existing loan with SSS with a balance of NINE THOUSAND NINE
HUNDRED SIXTY-SEVEN (P 9,967.44) pesos and 44/xx. The same is to be paid
through a bi-monthly deduction from my salary in the amount of four
hundred fifteen (P 415.31) pesos and 31/xx;

5. I will be submitting my resignation to T’NALAK Labor Services Cooperative

on or before May 31, 2019;

6. I hereby categorically declare that I intend and will continue to pay the
said SSS loan balance out of my personal money;

7. As regards the SSS contribution, I intend to continue the payment of

premium contribution as a Voluntary member;

8. I am executing this affidavit to attest to the truth of the foregoing facts

and for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 27th day of

May, 2019 at Kapalong, Davao del Norte.

Affiant

SUBSCRIBED AND SWORN to before me this 27th day of May, 2019 at

Kapalong, Davao del Norte, Philippines.