Affidavit of Loss - Sss

AFFIDAVIT OF LOSS REPUBLIC OF THE PHILIPPINES) _____________________________ ) S.S. I, MARIA ANA A. MANUEL., Filipino, of legal age, residing at #4 Joshua Street Metro Gate Complex, Meycauayan, Bulacan, after having been sworn in accordance with law hereby depose and state:

That sometime in May of this year, I left my SSS ID with SSS No. 336084325-0 in the Emergency Room of St. Luke’s Hospital in Quezon City when I had my sick daughter checked That when I got back to look for it, it was nowhere to be found That I am executing this affidavit to attest to the truth of the foregoing and to request from the Social Security System Office of Meycauayan City, a new SSS ID. IN WITNESS WHEREOF, I have hereunto set my hand this 13th day of October. 2009 at Meycauayan City.

MARIA ANA A. MANUEL

SUBSCRIBED AND SWORN to before me, this ____ day of ______________, 200___ in ___________________ City, with affiant exhibiting his CTC No. _______________ , Issued on ______________________ at _________________________. NOTARY PUBLIC Until December 31, 200___ Doc. No. : ________; Page No. : ________; Book No. : ________; Series of 2009.