REPUBLIC OF THE PHILIPPINES)

IN THE CITY OF BATANGAS ) S.S.

AFFIDAVIT OF LOSS

I, VICTORIA B. MERCADO, single, of legal age,

Filipino, and resident of Brgy. Bagong Barrio, Caloocan
City, after having been sworn to in accordance with law,
hereby depose and say, that:

[1] I am a member of the Social Security System

(SSS) and as such, I was issued an Identification Card with
number, 0386327834,

[2] Recently, when I was going over my documents

and other files, I discovered that the said SSS Identification
Card was missing and efforts to locate the same proved in
vain;

[3] I am executing this affidavit to attest to the truth

of all the foregoing facts and to inform the proper
authorities particularly the Social Security System for the
purpose of securing a replacement in lieu of the lost one

IN WITNESS WHEREOF, I have hereunto set my hand

this August 25, 2018 at Batangas City, Philippines.

VICTORIA B. MERCADO
Affiant
TIN: 123-580-591

SUBSCRIBED AND SWORN to before me this August 25, 2018

in Batangas City.

SONNY JOSE M. RICABLANCA

Notary Public
Until 31 December 2018
PTR No. 3022119 01-03-18 Batangas City
IBP Lifetime No. 019079
Doc. No. 94; Roll No. 69544 Serial No. 2017-20
Page No. 20; MCLE Exempted, pursuant to MCLE
Book No. XII Governing Board Order No. 1, S.2008
Series of 2018.
Zenaida Arcade, 43 M.H. del Pilar St.,
Batangas City