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Republic of the Philippines )

Camiling, Tarlac ) S.S.

AFFIDAVIT OF NO EARNINGS

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,
Philippines.

PACITA V. LORENZO
Affiant

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.