Republic of the Philippines)

City of Manila ) S.S.

AFFIDAVIT OF LOSS

I, JUANA SANTOS, Filipino, married, of legal age and a resident of #456 Vicente Cruz Street,
Manila, under oath, do hereby and so state that:

1. I was issued a UMID ID with no. 6789 by the Social Security System (SSS) on June 10,
2019, valid until June 10, 2029;
2. On February 25, 2023, I lost my wallet containing my UMID ID which was in my
clutch bag after riding a tricycle to Bustillos public market for groceries;
3. I reported the incident to the market manager of Bustillos on February 26, 2023;
4. After diligent search until March 1, 2023, the said wallet containing my UMID ID
could no longer be located;
5. I am executing this affidavit to attest the truthfulness and veracity of the above-
stated declarations and to request for the issuance of a new UMID ID.

IN WITNESS WHEREOF, I hereunto affixed my signature this 28 th of March 2023, in the City
of Manila.

JUANA SANTOS
Affiant

SUBSCRIBED AND SWORN to before me a Notary Public, for and in the City of Manila,
this 28th day of March 2023, the affiant exhibiting to me her competent proof of identity.

ATTY. RISTEL MAE B. TAGUDANDO

Notary Public for Manila
Unit 1127, Telstar Tower, Espana,
Manila
IBP No. 112799; 12/31/2024
Roll No. 77777