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AFFIDAVIT OF LOSS

REPUBLIC OF THE PHILIPPINES)


QUEZON CITY
) S.S.
I, GENIVER I. ILOWA, a Filipino citizen, of legal age, married and with address at 108-C
Presidential Street, Brgy. Batasan Hills, Quezon City, Metro Manila, Philippines, after having been duly
sworn in accordance with law, hereby depose and say:
That I am a member of the Social Security System with SSS ID No. 33-1845463-3;
That as such, I was issued my corresponding SSS Digitized ID;
That my said SSS Digitized ID was misplaced and lost and could no longer be located
notwithstanding diligent search made;
That I have executed this affidavit to establish the truth of the foregoing facts for the
information of the proper authorities and for whatever legal purpose it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand on this __________________________ at
Quezon City, Philippines.

GENIVER I. ILOWA
Affiant
SSS I.D. No. 33-1845463-3
SUBSCRIBED AND SWORN to before me this _____________________________ at Quezon
City, Philippines.

Doc. No.
Page No.
Book No.
Series of 2015