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REPUBLIC OF THE PHILIPPINES )

CITY OF ANGELES ) - s.s.

AFFIDAVIT OF LOSS

I, REMEDIOS M. TOLENTINO, of legal age, Filipino, widow, with


residence at No. 1 Arive St., Holy Angel Village, City of San Fernando,
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. 02-
1073135-0;

2. On, while I was boarded a public utility vehicle in my way home. When I
got off the jeepney, I noticed that my wallet was missing, containing
therein my said Social Security System ID Card (SSS) and important
cards and a small sum of money, probably it fell on the jeepney or
someone took it, without 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
and for any other legal purpose(s) it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 2nd day of


June 2009 in Angeles City, Philippines.

REMEDIOS M. TOLENTINO
Affiant

SUBSCRIBED AND SWORN to before me this 2nd day of June 2009 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, 2009
Page No. ____; PTR No. ACF0214743
Book No. VIII; 01-06-2009, Angeles City
Series of 2009. Roll of Attorney’s No. 40037
IBP Lifetime Member No. 00415
Commission No. 2008-163
Villanueva De Leon Hipolito Tuazon
167 Sto. Domingo, Angeles City
REPUBLIC OF THE PHILIPPINES )
CITY OF ANGELES ) - s.s.

AFFIDAVIT OF LOSS

I, JOEL L. DAVID, of legal age, Filipino, married, with residence at District


8, Block 106 Lot 7, Pandacaqui Resettlement, Mexico, 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. 03-
7756502-9;

2. My Social Security System 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 11th day of


March 2010 in Angeles City, Philippines.

JOEL L. DAVID
Affiant

SUBSCRIBED AND SWORN to before me this 11th day of March 2010 in


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

MARIA IMELDA Q. TUAZON


Notary Public
Doc. No. 168; Until December 31, 2009
Page No. 104; PTR No. AC1828439
Book No. IX; 01-04-2010, Angeles City
Series of 2009. 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