AFFIDAVIT OF LOSS

That I, DENISA R. ARCILLA, Filipino, of legal age, with residential address at

Block 5 Lot 1 JONELTA Homes, Sto. Nino, Binan, Laguna, after having been
duly sworn to in accordance with law, do hereby depose and state;

1. That issued in my favor an identification card by the Social

Security System (04-0932030-7) and PAG-Ibig (1020-089-6808);

2. That sometime in December 8, 2021, I was rummaging through my

important belongings in my cabinet when I found out that the said
SSS ID and Pag-Ibig ID are missing;

3. That I exerted all efforts to find and recover IDs, however, the
search remained futile and is deemed beyond recovery;

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

foregoing and to apply for the issuance of another SSS ID and Pag-
Ibig ID, as mentioned above, and for whatever legal purposes it
may serve;

Further, affiant sayeth naught.

DENISA R. ARCILLA
Affiant

SUBCRIBED AND SWORN TO BEFORE ME, this _______________, affiant

presenting to me his/her _____________________with photograph and specimen
signature. ______________________________. That the foregoing affidavit was
freely and voluntarily issued by affiant.

NOTARY PUBLIC

Doc No. _____;

Page No. _____;
Book No. _____;
Series of 2022.