Republic of the Philippines )

______________ )S.S.

AFFIDAVIT

I, __________________ of legal age, married and a resident of

______________________ after having been duly sworn on oath in accordance
with law, do hereby depose and say:

1. That I am a member of the Social Security System (SSS) with

Employer Number _____________;

2. That on ______________, I started operating and managing

_________________, registered _________________ located in
______________________________, however, it was only on July 20, 2017
that I was able to register with the SSS as a self-employed individual
as I was not aware that I was legally bound to register upon operating
the business;

3. That such failure to register with the SSS upon operation was an
honest mistake and was not intended to evade any legal obligation;

4. That I am executing this affidavit in truth to serve as an explanation,

to attest to the truth of the foregoing facts and for all legal purposes it
may serve.

IN WITNESS WHEREOF, I have hereunto set my hand _____ day of

_______, 2019 in _________, Philippines.

__________________________
Affiant

SUBCRIBED AND SWORN TO before me this _____ day of ______,

2019 in _______, Philippines, affiant exhibiting to me her valid proof of
identification by way of ______________________.

Doc. No.
Page No. Notary Public
Book No
Series of 2019.