REPUBLIC OF THE PHILIPPINES )

QUEZON CITY ) S.S.

AFFIDAVIT OF EXPLANATION

I, ARSENIA VENEZUELA CUEBILLAS, of legal age, Filipino, married and a

resident of BLCK 214 LOT 44 YUAN STREET NORTH FAIRVIEW QUEZON CITY,
after having been duly sworn to in accordance with law, depose and state:

1. That, I am a claimant of Burial Benefits of SSS of my husband ANTONIO

PEÑA CUEBILLAS.
2. That, based on the SSS record my Name Registered was ARSENIA
ABREMATIA CUEBILLAS that was the same on my marriage contract I don’t
have any Idea on that time that in my Birth Certificate I used my mothers
Middle and Last Name and in my other government ID’s it was ARSENIA
VENEZUELA CUEBILLAS; the reason on these erroneously in my SSS
Record and Marriage Contract was my mother and Father not married when I
was born, so on my Birth Certificate my mother decided to used her Middle
and Last Name that it was appeared on my Birth Certificate and I don’t have a
copy of my Birth Certificate that time so I taught the last name registered on
Birth Certificate was my Father’s Last Name;
3. That, further I am manifesting the truth of the foregoing that my
aforementioned statement is true and correct to the best of my knowledge
and belief;
4. That I am executing this affidavit in order to attest the veracity of truth of the
foregoing explanation for claiming of my Husband SSS Burial Benefits.

IN WITNESS WHEREOF, I have hereunto set my hand on this 2 nd day of May

2023 at Quezon City, Philippines

ARSENIA VENE-ZUELA CUEBILLAS

Affiant

SUBSCRIBED AND SWORN to before me this 2nd day of May 2023 at Quezon
City, Philippines

Doc. No.: _____________ NOTARY PUBLIC

Page No.: _____________
Book No.: _____________
Series of 2023