REPUBLIC OF THE PHILIPPINES )

DASMARIÑAS CITY, CAVITE ) S.S.

AFFIDAVIT OF LOSS
I, FLORENZE VILLARIN POMENTO, of legal age, single, Filipino Citizen, and with
postal and residence address at Block 46 Lot 9 Phase 2 Windward Hills Subdivision, Burol 1,
Dasmarinas City, Cavite, after having been duly sworn to in accordance with law, hereby depose
and say:

That I am a bonafide member of Social Security System (SSS), whereas they issued an
Unified Multi-Purpoose Identification Card (UMID) with no. 0111487334046;

That the said SSS Unified Multi-Purpose Identification Card was accidentally
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 6 th day of May 2022 at
Dasmarinas City, Cavite, Philippines.

FLORENZE VILLARIN POMENTO

Affiant

SUBSCRIBED and SWORN to before me on the date and place above-written, affiant
exhibiting to me his/her TIN: 467-577-377-000.

Doc. No. 152

Page No. 30
Book No. 09
Series of 2022