REPUBLIC OF THE PHILIPPINES )

PROVINCE OF TARLAC ) S.S.

MUNICIPALITY OF CAMILING )

AFFIDAVIT

I, JAYSON FUENTES MIGUEL, of legal age, single, Filipino

citizen, and a resident of Barangay San Vicente, Santa Ignacia,
Tarlac, Philippines, after having been duly sworn to in accordance
with law, do hereby depose and state THAT:

1. Sometime in 2012, I applied and became a member of the

Social Security System of the Philippines (SSS), the
following information were registered in the records of the
SSS, to wit:

Member Name : MIGUEL, JAYSON FUENTES

SS Number : 02-3461562-7

2. When I was employed as a Service Crew by our agency

(Jobcon Worx), deployed at the Chowking Capas, Tarlac
Branch in the year 2014, without my knowledge, my
employer processed for my membership registration before
the above-said agency, thus, another SS Number was
assigned under my name which is 02-0932310-6;

3. Lately, when I applied for an SSS Identification Card before

the said agency at its Camiling, Tarlac branch, they
discovered that there were two (2) SS Numbers appearing
under my name which are SS Numbers 02-3461562-7
and 02-3616278-3;

4. I am executing this affidavit to request the SSS Camiling

Branch to cancel the SS Number 02-3461562-7 and to
transfer the contributions/premiums that were made under
the said account (if there were any) in my other SS account
number 02-3616278-3;

5. Finally, I am executing this Affidavit to attest to the truth of

the foregoing statements and for all legal intents and
purposes this may serve;
 IN WITNESS WHEREOF, I have hereunto set my hand this
th
7 day of June, 2017 at Camiling, Tarlac, Philippines.

JAYSON F. MIGUEL
Affiant

SUBSCRIBED AND SWORN to before me on the date and

place indicated above. Affiant exhibited to me his PhilHealth ID Card
with PIN: 07-201595402-8 issued by the Philippine Health
Insurance Corporation.

Doc. No.:_______;
Page No.:_______;
Book No.:_______;
Series of 2017.