REPUBLIC OF THE PHILIPPINES )

……………………………………………..)
x--------------------x

AFFIDAVIT OF LOSS OF SSS ID

I, AAA, a Filipino citizen, of legal age, single, and a resident of

___________________, having been duly sworn in accordance with law, do
hereby depose and state:

1. That I was issued an SSS ID;

2. That sometime around August 2022, when I looked for the said SSS
ID where I normally place it, I could no longer find the same;

3. That despite diligent search and efforts to locate the foregoing SSS
ID, I could not find the same such that I now believe that it is now
lost beyond recovery;

4. That as such, I am executing this Affidavit of Loss to attest to the

truth of the foregoing facts.

IN WITNESS WHEREOF, I have hereunto set my hand this

______________, 2022 at ___________________, Philippines.

AAA
Affiant
I.D No. ____________

SUBSCRIBED AND SWORN to before me, a Notary Public in

_____________, this _________________, in ___________________, by the
Affiant who presented to me her competent evidence of identity.

Doc No…………….
Page No…………..
Book No…………..
Series of 2022.