Republic of the Philippines )

Marikina City ) S.S.

AFFIDAVIT OF LOSS
I, ELLA GIBSON MARTIZANO, Filipino, of legal age, resident of #35B Katipunan
St, Marikina Heights, Marikina City, after being sworn to in accordance with law, hereby depose
and state that:
1. I am a holder of a SSS Identification Card Bearing No. 03-8911610-7 issued by
the Social Security System.
2. However, said SSS Identification Card was stolen sometime on August 23, 2023
somewhere in the vicinity of my residence.
3. Said SSS Identification Card is now beyond recovery and is considered lost for
legal purposes.
4. Said SSS Identification Card was not confiscated for reason of any violation of
Professional Regulation Commission rules or regulations.
5. I am executing this affidavit to attest to the truth of all the foregoing facts and for
whatever legal purposes it may serve.
6. I attest to the truth of the foregoing facts.

IN WITNESS WHEREOF, I hereunto set my hand on this 29 August 2023 at Marikina

City, Metro Manila, Philippines.

ELLA GIBSON MARTIZANO

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, a Notary Public for and in the City of
Marikina, Philippines, this 29 August 2023, by ELLA GIBSON MARTIZANO, affiant
exhibiting to me as competent evidence of identity her _____________________.

WITNESS MY HAND AND NOTARIAL SEAL on the date and in the place written
above.

ATTY. LIZA JANE B. ESTAÑO

Notary Public for City of Marikina
Until December 31, 2023
2nd Floor, JNC Building, Bayan – Bayanan Avenue
Concepcion Uno, Marikina City
Attorney’s Roll No. 57533
IBP No. 264081 / 01-03-23 / RSM
PTR No. 9390201 / 01-03-23 / Marikina City
MCLE Compliance No. VII–0020076/April 14, 2025
Telephone No. (027) 956-5345

Doc. No. _________ ;

Page No. _________ ;
Book No. _________ ;
Series of 2023.