REPUBLIC OF THE PHILIPPINES) PARAAQUE CITY )

AFFIDAVIT OF LOSS

I, MA. VANESSA BANZUELA-SOLOMON, of legal age, Filipino citizen, and a resident of B1 L20 Apitong St., Paranaque City do hereby depose and say : a. That I was a member of the Social Security System with account no. 33-8912616-5; b. That I was issued an Identification Card by the Social Security System; c. That unfortunately the said SSS ID was misplaced last June 13, 2013; d. That I exerted all efforts to locate the same but to no avail; e. That I am executing this Affidavit to attest to the truth of the foregoing facts for purposes of issuance of another one with the name MA. VANESSA B. SOLOMON; IN WITNESS WHEREOF, I have hereunto affixed my signature this _______day of August 2013 at Paraaque City, Philippines.

MA. VANESSA BANZUELA-SOLOMON Affiant CTC No. __________________ Issued on: _________________ Issued at Paraaque City

SUBSCRIBED AND SWORN TO BEFORE ME this ______ day of August 2013 at Paraaque City, Philippines.

Doc. No. _____. Page No. _____. Book No. _____. Series of 2013.