REPUBLIC OF THE PHILIPPINES)

PROVINCE OF OCCIDENTAL MINDORO) S.S.

MUNICIPALITY OF SABLAYAN)

AFFIDAVIT OF KNOWLEDGE

(CIRCUMSTANCE THAT UPON FILING AND APPROVAL OF RETIREMENT LUMPSUM,

THE ONLY BENEFIT CLAIMABLE IS FUNERAL/BURIAL BENEFIT)

I, OFELIA O. AGUILAR, Filipino, of legal age, married, with residence and

postal address at Barangay Sto. Niño, Sablayan, Occidental Mindoro,
Philippines, after being duly sworn to in accordance with law, hereby depose
and state:

1. That I am a member of Social Security System (SSS) with SSS No. 03-
6748475-9;

2. That on ____ of _____________, 201____ I retired as an employee of

Rural Bank, ___________ Branch.

3. That last ___ of ___________, 201____ I filed an application to claim my

retirement lump sum from SSS;

4. That I am fully knowledgeable, that once such application is granted,

the only remaining benefit claimable from SSS would be funeral/burial benefit;

5. As such, I am executing this Affidavit of Knowledge to attest to the

truth of the foregoing and to support my application for the grant and release
of my retirement lump sum.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at

_____________, Philippines.

OFELIA O. AGUILAR
AFFIANT

SUBSCRIBED AND SWORN to before me, this _____________ day of ______________, in

the City of __________________, by ___________________ with Community Tax Certificate
No.________________ issued on __________________at_____________.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of ______;