REPUBLIC OF THE PHILIPPINES )

PROVINCE OF PAMPANGA ) S.S.

MUNICIPALITY OF GUAGUA )
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AFFIDAVIT OF LOSS

I, ARNEL G. FERNANDO, of legal age, and a resident of San Antonio,

Guagua, Pampanga after having been duly sworn in accordance with law, hereby
depose and state:

That I am a member of Social Security System and I was issued a SSS

ID;

That the said SSS ID was placed in the drawer in our house is missing,
probably it was misplaced and nowhere to be found;

I tried to recover it but I was not able to do so. I further exerted diligent
efforts to locate it but all proved an exercise of futility, hence, my SSS ID is now
considered lost;

I am executing this Affidavit to attest to the truth and veracity of all the
foregoing with the intent of requesting the Office of the Social Security System
at Guagua, Pampanga, to issue me another SSS ID in lieu of the lost one.

IN WITNESS WHEREOF, I have hereunto set my hand this 19th of

November, 2021 at Guagua, Pampanga.

ARNEL G. FERNANDO
Affiant

SUBSCRIBED AND SWORN to before me this 19th of November, 2021

at Guagua, Pampanga, Philippines.

Doc. No.
Page No. Notary Public
Book No.
Series of.