REPUBLIC OF THE PHILIPPINES)

CITY OF TAGBILARAN )S.S.

AFFIDAVIT OF INCOME

I, FRANCIS ABU, of legal age, Filipino, widower and a resident of Barangay

Sta. Cruz, Sagbayan, Bohol, Philippines, after having been duly sworn to in
accordance to law hereby depose and say:

1. That I am the same FRANCIS ABU, who is a bonafide Self-Employed

member of the Social Security System (SSS) with SS No. xxxxxxxxx;

2. That I was engaged in the trade of masonry;

3. That I stopped to work as a mason effective December 31, 2014 due to my

old age, and as a consequence, I no longer have earnings as a mason.

4. That I am executing this affidavit freely and voluntarily to attest to the truth of
the foregoing facts in my application for retirement claim benefit before the
Social Security System office and for whatever legal purposes this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 16th day

of March 2015 at Tagbilaran City, Bohol, Philippines.

FRANCIS ABU
Affiant
xxxxxxxxx
Office of the Senior Citizen Affairs
Tagbilaran City

SUBSCRIBED AND SWORN to before me this 16th day of March 2015 at

Tagbilaran City, Bohol, Philippines. Affiant exhibited me his competent evidence of
identity indicated above.