REPUBLIC OF THE PHILIPPINES}

DONE: IN THE CITY OF BAGUIO } S.S.

x ------------------------------------------- x
AFFIDAVIT OF LOSS
I, MERLINA B. SACYANG, of legal age, Filipino citizen,
married and with residence at Pias, Baguio City, on oath, states:
1. I have been issued an Identification Card by Social Security
System (SSS) with a number ____________.
2. Sometime in December of 2005, I have lost the said SSS ID
Card because I was a victim of pickpocket in Davao City.
3. I have exerted all efforts in locating the ID Card but to no avail.
and
4. I am now executing this affidavit to attest to the veracity of the
foregoing narration for the purpose of acquiring a new SSS ID.
IN WITNESS, I have hereunto set my hand this 15th day of March
2016, in the City of Baguio, Philippines.

_______________________
MERLINA B. SACYANG
Affiant
SUBSCRIBED AND SWORN to before me, in the City of
Baguio, Philippines, this 15th day of March 2016, as she presented to
me her Postal ID Card with No. __________, that she is the same
person who personally signed the foregoing affidavit before me and
acknowledged that she executed the same. That I have avowed
under penalty of law to the whole truth of this document.

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