REPUBLIC OF THE PHILIPPINES )

DANAO CITY ) S.S.

AFFIDAVIT OF LOSS

I, ERWINA G. GARBO Filipino, of legal age, married, and a resident

of Danao City, after having been duly sworn in accordance with law,
hereby depose and say:

1. That I am a holder of a Social Security System (SSS)

identification card bearing the numbers 06-1488264-3;

2. That I used to put said ID Card in my personal envelope with my

other documents;

3. That sometime in the year 2018, when I arrived home, I

discovered that my SSS ID card was no longer inside the said
envelope;

4. That diligent effort to locate and search in places where I have

been on that day, said ID was nowhere to be found;

5. That said SSS ID card was not confiscated by the authorities for
any reason. Neither did I violate any rules and regulations;

6. That I am executing this affidavit to attest to the truth of the

foregoing facts and to request for a replacement of said SSS ID
card;

IN WITNESS WHEREOF, I have hereunto affixed my signature this

1st day of June 2019 at Danao, Philippines.

ERWINA G. GARBO
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in

and for Danao City 1st day of June 2019 at Danao, Philippines. Affiant
personally came and appeared with her Voter’s ID VIN 2223-0331A-
K1873EGG20000-2, bearing her photograph and signature, known to me
as the same person who personally signed the foregoing instrument before
me and avowed under penalty of law to the whole truth of the contents of
said instrument.

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