Republic of the Philippines)

City of Binan, Laguna

) S.S.
AFFIDAVIT OF LOSS

I, PARRO, WILLIE BARCELA, Filipino, of legal age, single,

and a resident of Block 47, Lot 36, Timbao, Binan City, Laguna,
after having been sworn in accordance with law, do hereby
respectfully depose and state:
THAT sometime in December 2, 2014 while on my way
going to my sister in Alabang Muntinlupa, my wallet was lost;
THAT I have exerted my earnest effort to look for my wallet,
more importantly my SSS Identification Card with ID No.
3363538164 inside it;
THAT up to even date, there is no trace of my wallet nor my
SSS Identification Card that I believe it is now lost beyond
recovery.
That I am executing this Affidavit to attest to the truth of
the foregoing facts and for the purpose of securing a new SSS
Identification Card in lieu of the lost one.

IN WITNESS WHEREOF, I have hereunto set my hand

this _____________ at _____________ City, Philippines.
WILLIE BARCELA PARRO
(Affiant)
JURAT/CERTIFICATION
SUBSCRIBED AND SWORN to before me this ___th day of
_______ at the ___________. I hereby certify that I personally
examined the affiant and that I am satisfied that he voluntarily
executed and understood his affidavit.
NAME
PLACE
Willie Barcela Parro
________

CTC NO.
______

DATE
_______

NOTARY PUBLIC

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Series of 2015