Republic of the Philippines )

City of Dumaguete ) S.S.

x - - - - - - - - - - - - - - - - - - -x

AFFIDAVIT OF LOSS

I, MAY GLECYL LLANOS, of legal age, Filipino, married and with postal address at
Sta. Monica, Banilad, Dumaguete City, Negros Oriental, on oath, depose and say:

1. That I am a bonafide member of the Social Security System (SSS) with SSS No.
3401520568 and was eventually issued an ID thereof;

2. That sometime in 2017, I applied a job in a Recruitment Agency in Manila;

3. That as part of the requirements for my job application, I submitted my SSS ID

before the said recruitment agency;

4. That, however, my job application with the agency was eventually unsuccessful;

5. That when I returned to the said agency to take back the documents I have
submitted including my SSS ID, they could no longer return it to me;

6. That despite diligent search and efforts to locate my SSS ID, they could not find
the same such that I now believe that it is now lost beyond recovery;

7. That I hereby declare that the above SSS ID was not confiscated by the
government or any of its agencies for whatever purpose; and

8. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing
and to support the application for the issuance of new one in lieu of the one which
was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this 22nd day of January
2019 at Dumaguete City, Philippines.

MAY GLECYL LLANOS

Passport EC5548534
 AFFIANT

SUBCRIBED AND SWORN TO before me this 22nd day of January 2019 at

Dumaguete City Philippines, affiant exhibiting to me her valid proof of identification as
described above.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2019.