AFFIDAVIT OF LOSS

I, Ruby A. Magsael, of legal age, Filipino citizen, and resident of 2220 Cinco de Junio Street
Pasay City, Philippines, after being duly sworn in accordance with law, hereby depose and state
under oath:

1. That I am the lawful owner/holder of the following lost item/document: SSS ID No: 33-
94647723.

2. That the lost item/document was in my possession and custody, and I have exercised due
care and diligence to keep it safe and secure.

3. That I have made a diligent search and inquiry to locate the lost item/document but to no
avail. It is irretrievably lost and cannot be recovered.

4. That the loss of the said item/document was not due to any negligence, willful act, or
omission on my part.

5. That I am executing this Affidavit of Loss to attest to the truth of the foregoing facts and for
the purpose of applying for the issuance of a new/replacement item/document.

IN WITNESS WHEREOF, I have hereunto set my hand this 10th of January, 2024, in Pasay City,
Philippines.

________________________
RUBY A. MAGSAEL

SUBSCRIBED AND SWORN to before me this 10th of January, 2024, in Pasay City, Philippines,
affiant exhibiting competent evidence of identity through TIN ID with ID number 415-859-445,
issued on 2014.

WITNESS MY HAND AND SEAL.

Notary Public

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2024.