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REPUBLIC OF THE PHILIPPINES}

City of ________________....................}S.S.
AFFIDAVIT OF LOSS
I, ____________________, of legal age, married, Filipino, with residence
and postal address at ___________________________________, after being duly
sworn to in accordance with law, hereby depose and state that:
1. I am a holder of a Social Security System (SSS) ID with id No.
________________-;
2. The said SSS ID was lost and despite diligent search and efforts to
locate the same, I could not find it such that I believe that it is now
lost beyond recovery;
3. This Affidavit is being executed to attest to the truth of the foregoing
and for any legal purpose this may serve.
4. Further, I am executing this affidavit to humbly request the Social
Security System to allow me to secure a new SSS ID in lieu of the one
which was lost.

IN WITNESS WHEREOF, I have hereunto affixed my signature this


___________ at ______________________

Affiant
JURAT