REPUBLIC OF THE PHILIPPINES Ss.

CITY OF CEBU

AFFIDAVIT OF LOSS

I, GIL GALVEZ CABUENAS, of legal age, married, Filipino, and a resident 116
Cabantan St., Bo. Luz, Cebu City, Philippines, after being sworn in accordance with law, do
hereby depose and say THAT:

1. I applied and was issued by the Social Security System one (1) SSS Identification
Document bearing SS No. 0616420870.

2. However, sometime on September 2018, the abovementioned SSS ID was

misplaced, lost and could not be found.

3. The aforesaid SSS ID with SS No. 0616420870 was misplaced or lost in my

residence at 116 Cabantan St., Bo. Luz, Cebu City, and it appears that no amount of
evidence or reason can pinpoint to what truly transpired during that day.

4. Despite earnest efforts to locate said the SSS ID with SS No. 0616420870, the
same could no longer be found.

5. I am executing this Affidavit to attest to the truthfulness of the foregoing facts

and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 23 October 2019 in the
City of Cebu, Philippines.

GIL GALVEZ CABUENAS

Affiant

Type of ID: Passport

ID Number: P2802331B

SUBSCRIBED and sworn to before me, this 23 October 2019 in the City of Cebu, by
Affiant showing to me competent evidence of identity as indicated above.

Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2019.