REPUBLIC OFTHE PHILIPPINES)

)S.S.

AFFIDAVIT OF LOSS

That I, YENY CARALDE TINAWIN of legal age, Filipino citizen, married with
residence and postal address at PATIKOL, SAN ROQUE , GAPAN CITY ,NUEVA ECIJA
After having duly sworn to in accordance with the law do hereby depose and say:

That I am the owner and in possession of UMID ID with CRN number 0111-8213393-3
issued by Social Security System (SSS);

That the aforesaid SSS I.D.was lost due to unavoidable circumstances when it was
unfortunately misplaced;

That despite of diligent effort has been made tolookfor the said it mentioned above but
proved futile and must therefore considered it lost for all intents and purposes.

That I am executing this affidavit to attest to the truth off foregoing facts and to inform the
proper authorities concern and for whatever legal purpose this affidavit may serve.

IN WITNESS WHEREOF, I hereunto set my hand on this day of ,in the

City of .

YENY CARALDE TINAWIN

(PRINTED NAME AND SIGNATURE)
Affiant

SUBSCRIBED AND SWORN to before me on this this day of in the City of

______

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