Republic of the Philippines

City of Tacloban

S.S.

AFFIDAVIT OF RESIDENCY
I, _______________________, of legal age, Filipino, married, with
residence and postal address at Block 21, Lot 29, Phase 2B, Uranus Street,
V&G Subdivision, Brgy. 109-A, Tacloban City after having been duly sworn
to in accordance with law, do hereby depose and state the following:
1. I am bonafide member of the Social Security System with SS No.
33-25509775;
2. My home address was at Block 21, Lot 29, Phase 2B, Uranus
Street, V&G Subdivision, Brgy. 109-A, Tacloban City with postal code 6500
when the super typhoon Yolanda happened;
3. My capacity to pay my loan/s with SSS has been impaired by the
impaired by the calamity/disaster that occurred in the aforesaid address
which resulted to incurrence of interests and penalties of said loan/s;
4. I understand that in case it is proven that I have given false
information or misrepresentation in this document or in any other documents
submitted in connection with my Loan Restructuring Application, I
undertake to pay the outstanding balance of the loan including the condoned
penalty;
5. I am executing this Affidavit to attest to the truthfulness of the
foregoing statements.
IN WITNESS WHEREOF, I hereunto affix my signature this July
___, 2016 at Tacloban City, Philippines.
_________________________________
Affiant
I.D. No. ________________________
Issued by _______________________
Issued at _______________________

SUBSCRIBED AND SWORN TO before me, in the

City of Tacloban, this July ___, 2016 by the above affiant
showing his Identification Card and he confirmed that he
executed the foregoing knowingly and voluntarily.