REPUBLIC OF THE PHILIPPINES )

DASMARIÑAS CITY, CAVITE ) S.S.

AFFIDAVIT OF LOSS
I, RENATO RANA BERNAL, of legal age, single, Filipino Citizen, and with postal and
residence address at Area 3 Blk 7 Lot 6 Brgy. San Manuel 1, Dasmarinas City, Cavite, after
having been duly sworn to in accordance with law, hereby depose and say:

That I am the holder/owner of Identification Card with number 0369093897 issued by

Social Security System;

That sometime on 2021 the said Identification Card was misplaced/lost.

That despite of diligent efforts, the said Identification Card cannot be found and
considered as lost;

That I am executing this affidavit to attest to the truth of the foregoing facts for all legal
intents and purposes.

IN WITNESS WHEREOF, I have hereunto set my hand this 24th day of May 2022 at
Dasmarinas City, Cavite, Philippines.

RENATO RANA BERNAL

Affiant

SUBSCRIBED and SWORN to before me on the date and place above-written, affiant
exhibiting to me his/her PAG-ibig ID: 154153.

Doc. No. 292

Page No. 59
Book No. 10
Series of 2022