REPUBLIC OF THE PHILIPPINES)

CITY OF MANILA ) S.S.

x----------------------------x

AFFIDAVIT OF LOSS

I, Edgar P. Abejar of legal age, Filipino, married and a resident of San Isidro, Rodriguez, Rizal, after
having been duly sworn to in accordance with law, depose and state that;

That I am the authorized representative of WA SIERPAN ENTERPRISE with business address 2G-38
& 2F-38 168 Shopping Mall Soler St., Brgy. 268, San Nicolas, Manila

That WA SIERPAN ENTERPRISE was a holder of original CERTIFICATE OF REGISTRATION from Social
Security System, Binondo branch office. That the original Certificate of Registration was lost and
misplaced and cannot be located after diligent efforts to locate.

As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing and to support my
application for the retirement purposes.

IN WITNESS WHEREOF, I have hereunto set my hand this 4 th day of November, 2018 in Manila City,
Metro Manila, Philippines.

EDGAR P. ABEJAR
Affiant

SUBCRIBED AND SWORN TO before me this 4 TH day of November, 2018 at the City of Manila,
Philippines.

NOTARY PUBLIC
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2018