REPUBLIC OF THE PHILIPPINES )

PROVINCE OF CAVITE )
CITY OF DASMARINAS ) S.S.

AFFIDAVIT OF NON-EMPLOYMENT
I, DIOLETO MANGOPAS FORTUNATO, of legal age, married, Filipino, and with
postal and residence address at Sampaloc III, Dasmarinas City, Cavite, after having be duly
sworn to in accordance with law hereby depose and say:

That I am member of Social Security System (SSS) with No. 003-6499045-5

That in my employment history in (SSS) it was recorded that I worked in JB SPORTS

SHOP/JEAN S. FERNANDO, Reporting Date 11-2002 Employment Date 10-2002,
Document Source R3/R3;

That I request the office of the (SSS) to delete and remove the said employer where I
didn’t worked there;

That I am executing this affidavit to attest to the truth of the foregoing for all legal intents
and purposes.

IN WITNESS WHEREOF, I have hereunto set my hand this 19 th day of July 2019
Dasmarinas City, Cavite, Philippines.

DIOLETO M. FORTUNATO
Affiant

SUBSCIBED AND SWORN to before me on the day and place above-written, affiant
exhibiting to me his/her UMID NO. 003-6499045-5

Doc. No. 12
Page NoF. 03
Book No. 01
Series of 2019