REPUBLIC OF THE PHILIPPINES )

QUEZON CITY
) S.S.

AFFIDAVIT OF LOSS OF SSS ID CARD

I, ABEGAIL SARMIENTO DELOS SANTOS, Filipino, of legal age,
single and a resident of No. 187 Sarmiento Street, Brgy. Sta. Monica,
Novaliches, Quezon City, after having been duly sworn to in
accordance with law, depose and say:
1. That I am a holder of SSS Digitized Identification Card No. 340613899-7 issued by Social Security System.
2. Unfortunately, sometime in 2015, I lost my said SSS Digitized
I.D which I accidentally dropped.
3. Diligent efforts exerted to find my said SSS Digitized
Identification Card proved futile. Hence, for all intents and
purposes, said document is now considered as forever lost
and/or beyond recovery.
I am executing the foregoing Affidavit in order to attest to the fact
of loss of subject SSS Digitized I. D Card, in support of my application
for Unified Multipurpose ID (UMID) Card with the Social Security System
and for other legal purposes this may serve.
IN WITNESS WHEREOF, I have hereunto affixed my signature this
4 day of August 2016 in Quezon City.
th

ABEGAIL SARMIENTO DELOS

SANTOS

Affiant
SUBSCRIBED AND SWORN TO before me, a Notary Public for and
in Quezon City, this 4th day of August 2016, affiant exhibiting to me
Voters Identification Card No. 7404-2352B-B2188ASD20000, duly
issued by Commission on Elections at Second District of Quezon City.
Witness my hand and seal on the date and place written above.
Doc. No. 308
Page No. 63
Book No. XXVII
Series of 2016

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