Republic of the Philippines )

Camiling, Tarlac ) S.S.

AFFIDAVIT OF NO EARNINGS
I, FLORANTE DOMINGO ALEJO, JR., 60 years old, Filipino citizen,
married and a resident of Barangay Bobon 1st, Camiling, Tarlac, Philippines,
after having been duly sworn to in accordance with law do hereby depose and
state THAT:

1. I became a self-employed member of the Social Security System

(SSS) as I was then engaged in farming;

2. However, starting March 1, 2015, due to health reasons and old age,
I ceased to work as a farmer and did not engage in any gainful
occupation up to present;

3. I am executing this Affidavit in support of my Retirement Claim from

the SSS;

4. Finally, I am executing this Affidavit to attest to the truth of the

foregoing statements and for all legal intents and purposes it may
serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 14th

day of March, 2016 at Camiling, Tarlac, Philippines.

FLORANTE D. ALEJO, JR.

Affiant

Witness:
_________________
Perlita R. Alejo
Wife

SUBSCRIBED AND SWORN to before me on the date and place

indicated above. Affiant exhibited before me his SSS ID Card bearing his SS
No. 02-3227844-8 issued by the Social Security System.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2016.