REPUBLIC OF THE PHILIPPINES)

City of Cebu ) S.S.

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AFFIDAVIT OF LOSS

I, ROWENA AMPO AGOSTO, Filipino, of legal age, single and with residence
at 321-B Creekside, Sikatuna St., Zapatera, Cebu City, Philippines, after being duly
sworn to in accordance with law, hereby depose and state:

1 That I am a bona fide SSS member and holder of SSS I.D. No. 06-2353617-1;

2 That sometime last March 2020, said SSS I.D was misplaced and got lost;

3 That diligent search and effort to locate the said I.D proved futile such that I
believe it is now beyond recovery;

4 That I am executing this affidavit to attest to the truth of the foregoing facts
and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 14th day of

December 2020 at Cebu City, Philippines.

ROWENA AMPO AGOSTO

Affiant

SUBSCRIBED AND SWORN to before me this 14th day of December, 2020,

affiant showing to me her Passport No. P7795274A as competent proof of her identity.

Doc. No.______;
Page No.______;
Book No.______;
Series of 2020.