Republic of the Philippines)

Malaybalay City, Bukidnon) S.S

AFFIDAVIT OF LOSS

I, JEVILYN RAMOS OGDOL, of legal age, married, Filipino citizen and a

resident of Purok 3, Bagontaas, Valencia City, Bukidnon after having been duly
sworn to an oath in accordance with law, hereby depose and say:

1. That I am a member of the Social Security System (SSS), PagIbig, and

PhilHealth;

2. That I have been issued the corresponding identification cards by the

aforesaid government agencies;

3. That sometime in January 2018, all of the said identification cards

together with my other personal belongings were lost;

4. That all efforts were exerted to look for the aforesaid identification cards,
but it proved futile and it is beyond recovery;

5. That I am attesting to the truth and veracity of the foregoing facts;

6. That I am voluntarily executing this affidavit for whatever legal purpose/s

it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 27th day of

February 2018 at Valencia City, Bukidnon.

JEVILYN R. OGDOL
Affiant

SUBSCRIBED AND SWORN to before me this 27th day of February, 2018

at Valencia City, Bukidnon, Philippines. Affiant exhibited to me her Valencia City
Health Office I.D with No. 70180166 issued at Valencia City, Bukidnon. I HEREBY
CERTIFY that I have personally examined the affiant and I am satisfied that she
voluntarily executed and understood this affidavit.

Doc. No. ______

Page No. ______
Book No. ______
Series of 2018