I, PACITA VALENDIANO LORENZO, of legal age, Filipino
citizen, and a resident of Osmea St., Camiling, Tarlac, Philippines, after having been duly sworn to in accordance with law do hereby depose and state THAT:
1. I became a self-employed member of the Social Security
System as I was then engaged in farming;
2. However, starting May 1, 2014, due to health reasons and
old age, I ceased to work as a farmer and did not engage in any gainful occupation up to present;
3. I am executing this Affidavit in support of my Retirement
Claim from the SSS;
4. Finally, I am executing this Affidavit to attest to the truth of
the foregoing statements and for all legal intents and purposes it may serve.
IN WITNESS WHEREOF, I have hereunto affixed my
signature this 14th day of August, 2017 at Camiling, Tarlac, Philippines.
PACITA V. LORENZO Affiant
SUBSCRIBED AND SWORN to before me on the date and
place indicated above. Affiant exhibited before me her Unified Multi- Purpose ID card with CRN-0003-6355868-4 issued by the Social Security System of the Philippines.
Doc. No._______; Page No._______; Book No._______; Series of 2017.