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REPUBLIC OF THE PHILIPPINES)

PROVINCE OF NUEVA VIZCAYA) S.S.


MUNICIPALITY OF BAYOMBONG)

AFFIDAVIT OF LOSS

I, ROLANDO M. GUINSATAO JR., of legal age, married, Filipino citizen


and a resident of Brgy. Malasin, Dupax Del Norte, Nueva Vizcaya, after
having been duly sworn to an oath in accordance with law, do hereby
depose and state:

1. That I am a bonafide holder of a Social Security System Identification


Card with Number 01-1497765-0 which was issued under my name
by the Social Security System at Solano, Nueva Vizcaya ;

2. That said Identification Card was always in my possession as I placed


the same in my wallet and I have been carrying it with me wherever I
go. However, sometime in July 2018, when I was looking for it in my
wallet the said card was missing;

3. That finding the futility of recovering the said card, it is hereby


declared that the same is considered lost and beyond recovery;

4. That I attest to the veracity of the foregoing statements and hereby


execute this affidavit for the purpose of securing another SSS card in
lieu of the lost one.

IN WITNESS WHEREOF, I have hereunto set my hand this 1st day of


August 2018 at Bayombong, Nueva Vizcaya.

ROLANDO M. GUINSATAO JR.


Affiant
PhilHealth ID No. 06-025019168-8

SUBSCRIBED AND SWORN to before me this 1st day of August 2018


at Bayombong, Nueva Vizcaya.

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