Republic of the Philippines) Tarlac City, Tarlac ) S.S.

I, Teddy R. Salangsang, of legal age, married, Filipino citizen, with residence address at SS Village Barangay Binauganan ,under oath, depose and state: (1) I, loss my SSS Identification card with card number 03-8339550-0 (2) On January 10, 2009 I lost my wallet when I rode a bus going to Manila during which the said above ID is one of the content of the said wallet. (3) Diligent search of said Identification card and wallet with the bus company proved futile and unavailing. (4) I am executing this affidavit to comply with the requirements of Social Security System for the re-issue of said Identification Card. Affiant further sayeth naught.

TEDDY RODRIGUEZ SALANGSANG SUBSCRIBED AND SWORN to before me this day of February 17, 2009 in Tarlac City, Tarlac affiant exhibiting to his Community Tax Certificate No. __________ issued on _____________ at ____________.

Doc. No. ____; Page No. ____; Book No. ____; Series of

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