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REPUBLIC OF THE PHILIPPINES )

CITY OF ANGELES ) - s.s.

AFFIDAVIT OF LOSS

I, ANNA LYN M. BUŇAG, of legal age, Filipino, single, with resident


address at No. 563 Rizal St., Plaridel I Subd., Angeles City, Pampanga, after
having been duly sworn to in accordance with law, hereby depose and say, that:

1. I am the lawful holder of a Social Security System ID with SSS No. 33-
3049028-0;

2. My Social Security System (SSS) ID card was always kept in my wallet,


but recently, I discovered that the same was lost or missing. Said card
must have fell from my wallet without me noticing it.

3. Despite diligent efforts exerted by me to locate the same, all proved in


vain, thus, I now consider it as lost for all intents and purposes.

4. I have executed this affidavit to attest to the truth of the foregoing and to
serve as a supporting document to request the Social Security System to
issue me a new Social Security System ID card in lieu of the lost one and
for any other legal purpose(s) it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 9th day of


June 2011 in Angeles City, Philippines.

ANNA LYN M. BUŇAG


Affiant

SUBSCRIBED AND SWORN to before me this 9th day of June 2011 in


Angeles City, affiant, personally know to me to be the same person who
personally signed before me the foregoing “Affidavit” and acknowledged that she
executed the same.

MARIA IMELDA Q. TUAZON


Notary Public
Doc. No. ____; Until December 31, 2011
Page No. ____; PTR No. AC2223277
Book No. ____; 01-05-2011, Angeles City
Series of 2011. Roll of Attorney’s No. 40037
IBP Lifetime Member No. 00415
Commission No. 2010-256
Villanueva De Leon Hipolito Tuazon
167 Sto. Domingo, Angeles City