REPUBLIC OF THE PHILIPPINES)

MUNICIPALITY OF PIKIT               )S.S.

X----------------------------X

AFFIDAVIT OF NON-RECEIPT

I, ROLANDO TAPULAYAN LUMAYAG of legal age, Filipino, single and a resident of

Brgy. Kalacacan, Pikit, North Cotabato, after having been duly sworn to in accordance with law
hereby depose and say:

1. That I am a bona fide member of Social Security System (SSS) with SSS No:
09- 4097678-6
2. That I applied for issuance of SSS UMID;                 
3. That in SSS records it appeared that they issued me in 2018 said SSS UMID;                            

4. That I did not received the said SSS UMID;

5. That this affidavit has been executed to establish the fact that I did not
receive said SSS UMID;  
6. That I am executing this affidavit to attest to the veracity of all the
statements contained in this instrument, without any intention of
misleading the authorities as to the real circumstances surrounding non-
receipt of the said SSS UMID.

IN WITNESS WHEREOF, I hereunto signed this 21st day of December 2020, here at
Municipality of Pikit.

ROLANDO TAPULAYAN LUMAYAG

Affiant

SUBSCRIBED AND SWORN to before me this 21st day of December 2020, here at
Municipality of Pikit.

Doc. No.____
Page No.____
Book No.____
Series of 2020.