MLP-01271 (04-2016) REPUBLIC OF THE PHILIPPINES) PROVINCE OF ) 8s. AFFIDAVIT OF RESIDENCY Filipino, of legal age, singlefmarried, with residence address at after having been duly sworn fo in accordance with law, do hereby depose and state, that WITNESS my hand this at 3S 1 2 5. SUBSCRIBED AND SWORN to before me this | am a bonafide member of the Secial Security System with SS No. My address (work/home) was at with postal code when (name of calamity/disaster) happened, My capacity to pay my loan/s with SSS has been impaired by the calamity/disaster that occurred in the aforesaid adcress which resuited to incurrence of interests and penalties of the said loanis: | understand that in case it is proven that | have given false information or misrepresentation in this document or in any other documents submitted in connection with my Loan Restructuring Application, | undertake to pay the outstanding balance of the loan including the condoned penalty; | am executing this Affidavit to attest to the truthfullness of the foregoing statements. at affiant exhibiting hisihe 1D No. or Community Tax No issued on at ‘Administering Officer, Foreign Office