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Affidavit For SSS - Error of Entry - Sample

This affidavit states that [company name] erroneously included a deceased individual, with their SSS number and date of death listed, in an R3 report submitted to SSS for December 2014. The affiant requests that SSS rectify this error and delete the individual from their records. The affiant attached a death certificate as evidence of the erroneous inclusion.

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Roland Rosales
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1K views1 page

Affidavit For SSS - Error of Entry - Sample

This affidavit states that [company name] erroneously included a deceased individual, with their SSS number and date of death listed, in an R3 report submitted to SSS for December 2014. The affiant requests that SSS rectify this error and delete the individual from their records. The affiant attached a death certificate as evidence of the erroneous inclusion.

Uploaded by

Roland Rosales
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 )

__________________________ )S.S.

AFFIDAVIT

I, _____________, of legal age, Filipino citizen, with postal address at


_______________________________, after having been duly sworn to in accordance with law,
do hereby depose and say that:

1. I am the (state position in corporation) of _______________________, a corporation


duly organization under the laws of the Philippines with principal office address at
_________________________;

2. ________________ erroneously included ____________________, with Social Security


System (SSS) Number ___________________, in its R3 report submitted to the SSS for
the month of December 2014;

3. As evidence of the erroneous inclusion by ________________ in its R3 report is the


death certificate of the late ___________________ showing that he passed away on
November 15, 2013. A copy of the said death certificate is hereto attached and made an
integral part hereof as Annex A;

4. I am executing this affidavit in order to attest to the truth of the foregoing statements, for
the purpose of requesting the SSS to rectify the aforementioned error and delete the same
from their records and for whatever legal purpose it may serve.

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


__________________ at ______________, Philippines.

                                                                                    ________________
                                                                                                Affiant
                                                                                   

            SUBSCRIBED AND SWORN to before me this ____ day of _________________ in


_________, Philippines, affiant exhibiting to me as competent proof of identification
_______________________________________.

Doc. No. _____,


Page No. _____,
Book No. _____,
Series of _____,

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