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REPUBLIC OF THE PHILIPPINES) GAMU, ISABELA )S.S.

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AFFIDAVIT OF NO EARNINGS

I, IRENEO D. DOMINGO, of legal age, Filipino, married and a resident of Upi, Gamu, Isabela, after having been duly sworn to an oath in accordance with law, hereby depose and say, that: 1. I am the same affiant whose signature appears below; 2. For the past three (3) years I had no earnings to pay my loan with the SSS for the reason that I am not employed and no sufficient income;

3. I am executing this statement to attest to the truth of the facts stated above for whatever purpose this may serve best. 4. That my license/franchise to operate Tricycle on the line of GATODA was already cancelled since year 2010 and up to present I have no source of income.

IRENEO D. DOMINGO Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this __ day of ____ at Gamu Isabela, affiant having exhibited to me his CTC No. 00269320, issued at Gamu, Isabela

Doc. No ____ Page No. ____ Book No. ___ Series of 2013.