REPUBLIC OF THE PHILIPPINES )

MALOLOS CITY BULACAN )S.S

AFFIDAVIT OF CANCELLATION

I, MARIANITA LOLONG LOZADA, of legal age, Filipino, married to

Florencio R. Lozada, and a resident of 14 Donesa St. Canumay West, Valenzuela City,
after having been duly sworn to in accordance with law hereby depose and say:

1. That I am a member of Social Security System which hereby have the

following SS Number:

 03-4961223-0 Montiano, Marianita Locong

 03-5540584-2 Montiano, Marianita L
 03-6948709-2 Bernardino, Marianita L
 03-4831021-6 Lolong, Marianita Javier

2. That I am requesting to cancel the SS Number of the following:

 03-4961223-0 Montiano, Marianita Locong

 03-5540584-2 Montiano, Marianita L
 03-4831021-6 Lolong, Marianita Javier

3. Whereas, the SS Number 03-6948709-2 will be the one I will using from now
on, hence Bernardino, Marianita L will be change to Lozada, Marianita
Lolong;

4. That I am executing this affidavit to attest to the truth of the foregoing fact
and for all legal intents purposes it may serve, more particularly for the
requirement in SSS.

MARIANITA LOLONG LOZADA

Affiant

SUBSCRIBED AND SWORN to before me this April 27, 2021 hereat Malolos
City Bulacan.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2021