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Republic of the Philippines)

PROVINCE OF LAGUNA : S.S.


Municipality of Siniloan )
X------------------X

AFFIDAVIT OF LOSS

I, JOSEFA A. ROCERO, of legal age, single and presently residing at 150 P.


Burgos Street, Sta. Maria, Laguna, after having been duly sworn to in accordance with
law hereby depose and say:

That, I am an SSS member with ID No. 04 30035454;

That on March 20, 2017, I found out that my SSS ID was missing
because at that time I needed 2 valid IDs for a certain bank
transaction;

That I exerted full efforts to locate the same to my bag and to all
the places I could possibly keep it but to no avail;

That I am requesting the proper authority to replace me another


SSS ID card as it is very necessary in all my transactions;

That, I am executing this affidavit to attest to the truth of the


foregoing statement.

IN WITNESS HEREOF, I affixed my signature, this _______ day of March 2017


at Siniloan, Laguna, Philippines.

JOSEFA A. ROCERO
Affiant

SUBSCRIBED AND SWORN TO before me this ______ day of March 2017 at


Siniloan, Laguna.

ATTY. ESTHER R. REALEZA


Notary Public
PTR No. ___________________
Issued at Siniloan, Laguna
On ________________________

Doc. No. __________


Book No. __________
Page No. ___________
Series of ______
Republic of the Philippines)
PROVINCE OF LAGUNA : S.S.
Municipality of Siniloan )
X------------------X

AFFIDAVIT OF LOSS

I, CLEOTILDE R. ILAGAN, of legal age, Filipino, married, a resident of 074


Real Velasquez Street, Brgy. Bagong Pook, Sta. Maria, Laguna, after having been duly
sworn to in accordance with law hereby depose and say:

That, I am the holder of Landbank ATM Card with Account No.


3477-0344-88 issued by Landbank, Supreme Court Branch;

That, on April 1, 2017, I rode my motorcycle to withdraw from the


nearest ATM machine in our town but did not notice that I dropped
my wallet along the way with my ATM in it;

That I exerted full efforts to locate the same in the locality but to
no avail;

That, I am executing this affidavit to attest to the truth of the


foregoing statements and to request the issuance of a new ATM
card in lieu of the one which was lost.

IN WITNESS HEREOF, I have hereunto set my hand this 5th day of April, 2017 at
Siniloan, Laguna.

CLEOTILDE R. ILAGAN
Affidavit

SUBSCRIBED AND SWORN TO before me this 5 th day of April 2017 at


Siniloan, Laguna.

ATTY. ESTHER R. REALEZA


Notary Public
PTR No. ___________________
Issued at Siniloan, Laguna
On ________________________
Doc. No. __________
Book No. __________
Page No. ___________
Series of 2006
Republic of the Philippines)
PROVINCE OF LAGUNA: S.S
Municipality of Siniloan )
X-----------------X

A F F I D A V IT
I, GREGONIA RAMOS-PEREZ, of legal age, married, Court employee, with
residence and postal address at No. 70-A M. Acevida Street, Siniloan, Laguna, after
having duly sworn to in accordance with law hereby depose and state:

1. That, I was born on December 9, 1958 to Sps. Leodegario A. Ramos


and Mauricia V. de Leon in Siniloan, Laguna;
2. That, when I studied, I used the name GREGONIA de Leon RAMOS,
And even at the time when I was employed in the Municipal Circuit
Trial Court, Siniloan, Laguna, I used this name; Furthermore, all my
Records in 201 Files in the Supreme Court is in the name of
GREGONIA de Leon Ramos;
3. That, I was married to Virgilio A. Perez on June 23, 1985 in Siniloan,
Laguna and I used the name Gregonia L. Ramos;
4. That, when I secured copy of my Birth Certificate to the Municipal
Civil Registrar, Siniloan, Laguna, I found out that the registered name
is GORGONIA RAMOS, and my fathers registered name is
LUDEGARIO RAMOS;
5. That, I am executing this affidavit to attest the truth that GREGONIA
RAMOS and GORGONIA RAMOS is one and the same person;
6. That, I am requesting the proper authority to correct the typographical
error made in my birth certificate, from Gorgonia to GREGONIA
RAMOS, my real name I used since birth. Furthermore, I am
requesting that the name of my father be corrected from Ludegario to
LEODEGARIO.
7. That, I am executing this affidavit to attest the truth of the above-
mentioned facts.

In witness whereof, I have hereunto set my hand this 12th day of March 2007 at
Siniloan, Laguna.

GREGONIA R. PEREZ
Affiant
CTC No. _______________
Issued in Siniloan, Laguna

SUBSCRIBED AND SWORN TO before me this 12th day of March 2007


At Siniloan, Laguna, Philippines.

ATTY. ESTHER R. REALEZA


Notary Public
PTR No. __________________
Issued in Siniloan, Laguna
On _______________________
Doc. No. _______
Book No. _______
Page No. _______
Series of 2007
AU T H O R I ZATI O N

I hereby authorize Miss ELENA O. FORCADELA to act in my


behalf and to sign any pertinent papers relative to the processing of the
correction of my birth certificate with the National Statistics Office.
Quezon City. The corrected birth certificate is to be filed with the Supreme
Court for my 201 Files.
Siniloan, Laguna, March 12, 2007.

GREGONIA R. PEREZ
Republic of the Philippines)
PROVINCE OF LAGUNA: S.S.
Municipality of Siniloan )
X------------------X

JOINT AFFIDAVIT

WE, ONESIMA V. EGARGUE and EULALIA V. ANGLO, both of legal age,


both widower, both retired teacher and court employee, respectively, with residence and
postal address at Siniloan, Laguna, after having been duly sworn to in accordance with
law hereby depose and say:

1. That, we knew personally the Spouses Leodegario A. Ramos and Mauricia V.


de Leon, from Siniloan, Laguna;

2. That, we knew that they begot a daughter named GREGONIA L. RAMOS;

3. That , I (Onesima V. Egargue) knew the said Gregonia L. Ramos because she
was under my advisory during the elementary days when she was in Grade II;

4. That, I (Eulalia V. Anglo) knew her because she was employed in the
Judiciary in January of 1979, and we became co-worker until I retired in 2004;

5. That, we found out that when she got her birth certificate, her registered name
is GORGONIA RAMOS;

6. That, we knew that she used the name GREGONIA L. RAMOS since her
school days and since she was employed in the judiciary;

7. That we are executing this Affidavit to attest the truth that GREGONIA L.
RAMOS and GORGONIA RAMOS is one and the same person.

In witness whereof, we have hereunto set our hands this 12th day of March 2007 at
Siniloan, Laguna.

ONESIMA V. EGARGUE EULALIA V. ANGLO


Affiant Affiant
CTC No. _______________ CTC No. ______________
Issued on _______________ Issued on ______________
At Siniloan, Laguna At Siniloan, Laguna

SUBSCRIBED AND SWORN TO BEFORE me this 12th day of March 2007 at


Siniloan, Laguna, Philippines.

ATTY. ESTHER R. REALEZA


Notary Public
PTR No. ___________________
Doc. No. _____ Book No. _______ Siniloan, Laguna, ___________
Page No. _____ Series of 2007