Republic of the Philippines )

Camiling, Tarlac ) S.S.

AFFIDAVIT OF NO EARNINGS

I, PIO AGPALASIN QUINES, 61years old, Filipino citizen, married and

a resident of Barangay Pao 3rd, Camiling, Tarlac, Philippines, after having been
duly sworn to in accordance with law, do hereby depose and state THAT:

1. I became a self-employed member of the Social Security System

(SSS) of the Philippines when I was engaged in farming;

2. However, starting April 01, 2014, due to health reasons and old age, I
ceased to work as a farmer and did not engage in any gainful
occupation up to present;

3. I am executing this Affidavit in support of my Retirement Claim from

the SSS and to attest to the truth of the foregoing statements and for
all legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

13th day of March, 2017 at Camiling, Tarlac, Philippines.

PIO A. QUINES
Affiant

SUBSCRIBED AND SWORN to before me on the date and place

indicated above. Affiant exhibited before me his UMID ID with CRN-0111-
3488270-8, issued by the Social Security System, Philippines.

Doc No._____ Page No.______ Book No________ Series of 2015