AFFIDAVIT TO CORRECT SSS INFORMATION

KNOW ALL MEN BY THESE PRESENTS:

I, Ma. Emily Abastillas, Single, of Legal age, Filipino,

and a resident of ______________________________________,
Philippines, after having been duly sworn by law, do hereby
depose and say,

WITNESSETH:

1. That I am a bonafide member of the Social Security

System of the Philippines (SSS) with SSS no.
______________;

2. That my name in SSS records appears as Emily De

Jesus;

3. That my name as it appears in my birth certificate is MA.

EMILY ABASTILLAS a photocopy of my birth certificate is
attached in this affidavit as ANNEX A to prove this matter;

4. That I am single and despite having a common law

partner I have ,in fact, never been married as proved by the
photocopy of my Certificate of No Marriage (CENOMAR)
attached herein as ANNEX B; and

5. That I am executing this affidavit for purposes of correcting

the personal information that I have registered with the
SSS and for such other legal matters as may be necessary.

IN WITNESS WHEREOF, I hereunto affixed my signature

this ___ day of __________________ 2023, in the City of
_______________, Philippines.

MA. EMILY ABASTILLAS

AFFIANT

SIGNED IN THE PRESENCE OF:

________________________ __________________________
REPUBLIC OF THE PHILIPPINES)
CITY OF ______________ ) S. S.
X--------------------------------------------------------X

BEFORE ME, a Notary Public in and for the City and Province of
________________, personally appeared MA. EMILY ABASTILLAS,
identified by exhibiting to me his competent proof of identification written
below his name known to me and to me known to the same person who
executed the foregoing Deed of Adjudication, which instrument he
acknowledged to me to be his free and voluntary act and deed.

WITNESS MY HAND AND SEAL, this __ day of

_______________________________ 2023, at _____________ City, Philippines.

Doc No. ___

Page No. ___
Book No. ___
Series of 2023