Republic of the Philippines )

Province of Cavite ) S.S

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AFFIDAVIT OF LOSS

I, CELIA T. DE MAGNO, of legal age, Filipino, married with residence

address at 622 Cabanas St., Dalahican, Cavite City, Philippines, after having
been sworn to in accordance with law depose and state:

1. That, I am a lawful holder of SSS Identification Card with SSS No.

0353535264 issued by the Social Security System;

2. That, sometime on September 2019, I noticed that the said

Identification Card was missing;

3. Despite diligent search and efforts to locate the said Identification

Card, I could not find the same such that I now believe that it is now
lost beyond recovery;

4. That I am executing this affidavit to attest to the truth of the foregoing

and for whatever lawful purpose that it may serve.

IN WITNESS WHEREOF, I have hereunto set my name this 15 th day of

January, 2020, in Cavite City, Philippines.

CELIA T. DE MAGNO
Affiant

SUBSCRIBED AND SWORN to before me this 15th day of January, 2020 in

Cavite City, Philippines, Affiant exhibited to me her Senior Citizen ID with
number 19217.

Notary Public

Doc. No. 2301;

Page No. 253;
Book No. III
Series of 2020.