Republic of the Philippines)

Camiling, Tarlac
) S.S.

AFFIDAVIT
I SABAS ARENAJO LEGASPI, JR., of legal age, Filipino
citizen, and a resident of Quezon Ave., Poblacion E, Camiling,
Tarlac, Philippines, after having been duly sworn to in
accordance with law, do hereby depose and state THAT:
1. I am a member of the Social Security System (SSS)
when I was a self-employed single proprietor;
2. Starting July 28, 2016, due to health reasons and old
age, I ceased to work as a single proprietor and did
not engage in any gainful occupation, up to present;
3. I am executing this Affidavit in support of my
Retirement Claim from the SSS;
4. Finally, I am executing this Affidavit to attest to the
truth of the foregoing statements and for all legal
intents and purposes it may serve.
IN WITNESS WHEREOF, I have hereunto affixed my
signature this 12th day of August, 2016 at Camiling, Tarlac,
Philippines.
SABAS A. LEGASPI, JR.
Affiant
SUBSCRIBED AND SWORN to before me on the date
and place indicated above. Affiant exhibited to me his SSS ID
Card bearing his SS Number 02-0283001-0 issued by the
Social Security System of the Philippines.

Doc. No. _____

Page No. _____

Book No. _____

Series of 2016.