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Affidavit of Loss ID SSS

1. The affiant lost his wallet containing his SSS ID card in Tangub City on April 6, 2018 while searching for it diligently. 2. He executed an affidavit of loss on April 9, 2018 to attest to losing his SSS ID card and to support his application for a new one. 3. The affidavit was sworn before a notary public in Ozamiz City and establishes the facts of the loss to support the request for a replacement SSS ID card.

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328 views2 pages

Affidavit of Loss ID SSS

1. The affiant lost his wallet containing his SSS ID card in Tangub City on April 6, 2018 while searching for it diligently. 2. He executed an affidavit of loss on April 9, 2018 to attest to losing his SSS ID card and to support his application for a new one. 3. The affidavit was sworn before a notary public in Ozamiz City and establishes the facts of the loss to support the request for a replacement SSS ID card.

Uploaded by

lhemnaval
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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REPUBLIC OF THE PHILIPPINES )

Province of Misamis Occidental) S.S.


City of Ozamiz)
x---------------------------------------x

AFFIDAVIT OF LOSS

I, XXXXXXX, Filipino, of legal age, single and a resident of Archbishop


Residence, Chancery Office, Catadman, Ozamiz City, after having
been duly sworn in accordance with law, hereby depose and state:

1. That I am a holder of SSS ID No. XXXXX issued by the Social


Security System, Republic of the Philippines;

2. That on April 6, 2018 at around 3 o’clock in the afternoon, whle


I was in Tangub City , I lost my wallet which I usually place in my
left back pocket;

3. That I now believe that they are now lost beyond recovery
because despite diligent search and efforts to locate the said
wallet with my SSS ID Card and other pertinent documents, I
could not find them;

4. As such, I am executing this Affidavit of Loss to attest to the


truth of the foregoing and to support my application for the
issuance of a new SSS ID Card.

IN WITNESS WHEREOF, I have hereunto set my hand this 9th day of


April at Ozamiz City, Philippines.

_________________________________
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in and


for City of Ozamiz and the Municipalities of Clarin and Tudela in the
province of Misamis Occidental this 9th day of April, 2018. Affiant
personally came and appeared with Senior Citizen’s Identification Card
issued by the Local Government of Ozamiz City-Social Welfare and
Development Office issued on April 7, 2018 at Ozamiz City bearing
his photograph and signature, known to me as the same person who
personally signed the foregoing instrument before me and avowed
under penalty of law to the whole truth of the contents of said
instrument.

ATTY. LHEM JAPOS NAVAL


Notary Public for the City of Ozamiz
and the Municipalities of Clarin and
Tudela until December 31, 2019
Roll No. 67711
IBP Lifetime Roll No. 017073
PTR No. 3035024A-01/04/2018
TIN 923-610-646
MCLE Compliance Cert. No. VI-0004857

Doc. No. ___


Page No. ___
Book No. ___
Series of 20___

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