REPUBLIC
OF THE PHILIPPINES)
CITY
OF BAGUIO ) S.S
AFFIDAVIT OF L0SS
I, FERDINAND MAGELLAN, of legal age, married, Filipino Citizen, and with postal and
residence address at No. 43 Lower Quirino Hill Barangay, Baguio City, after
having been duly sworn to in accordance with law hereby depose and say:
1. That sometime on October 27, 2011, my
wallet where my SSS Identification Card numbered 01-0107604-3 issued by the
Social Security Service, was stolen while traveling from Baguio City to
Narvacan, Ilocos Sur;
2. That my effort to locate the same was to no
avail;
3. That I am executing this affidavit to
attest to the truth of the foregoing
facts
and circumstances and to facilitate my application for a replacement of the above-mentioned SSS Identification Card.
IN
WITNESS WHEREOF, I
hereunto set my hand this 4th day of November 2011 at Baguio City, Philippines.
FERDINAND
MAGELLAN
(Affiant)
SUBSCRIBED AND SWORN to before me, a notary public in and for
the City of Baguio this 4th day of November, 2011, at Baguio City,
Philippines, affiant appearing before me, who is personally known to me and who
signed the foregoing document in my presence and swore that she understood the
contents thereof and that the same was her free and voluntary act and deed.
Doc. No. 1 RYAN G. MALUBAY
Page
No. 1
Notary Public
Book
No. 1
Until December 31, 2011
Series of 2011 IBP No. 0301099; 07-06-11; Manila
PTR No. 825030; 04-26-11; Baguio City
Roll No. 57765
MCLE Governing Board Order No. 1 Series of
2008, dated July 4, 2008
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