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Republic of the Philippines )

Camiling, Tarlac ) S.S.


I, PACITA VALENDIANO LORENZO, of legal age, Filipino

citizen, and a resident of Osmea St., 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 as I was then engaged in farming;

2. However, starting May 1, 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;

4. Finally, I am executing this Affidavit 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 14th day of August, 2017 at Camiling, Tarlac,


SUBSCRIBED AND SWORN to before me on the date and

place indicated above. Affiant exhibited before me her Unified Multi-
Purpose ID card with CRN-0003-6355868-4 issued by the Social
Security System of the Philippines.

Doc. No._______;
Page No._______;
Book No._______;
Series of 2017.