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Kate Danielle - Affidavit of Loss

Jennifer Bermoy Hambre files an affidavit of loss for her lost Social Security System (SSS) identification card number 33-4809749-7. She states that she discovered the card was missing on December 13, 2016 after riding public transportation. Despite her efforts, she was unable to find the lost card. She executes this affidavit to establish the loss of the card and to support her application for a new SSS identification card.

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46 views2 pages

Kate Danielle - Affidavit of Loss

Jennifer Bermoy Hambre files an affidavit of loss for her lost Social Security System (SSS) identification card number 33-4809749-7. She states that she discovered the card was missing on December 13, 2016 after riding public transportation. Despite her efforts, she was unable to find the lost card. She executes this affidavit to establish the loss of the card and to support her application for a new SSS identification card.

Uploaded by

Flourescent Lamp
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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REPUBLIC OF THE PHILIPPINES )

Province of Bohol ) s.s.


City of Tagbilaran )
x - - - - - - - - - - - - - - - - - - - - - - - - -/

AFFIDAVIT OF LOSS

I, JENNIFER BERMOY HAMBRE, Filipino, of legal age, married, and a resident of


Purok 1, Brgy. Basdio, Loon, Bohol, after being duly sworn in accordance with law, depose and
state:

1. That I am a bona-fide holder of a SSS identification card No. 33-4809749-7 issued to


me by the Social Security System;

2. That to my surprise, I discovered last December 13, 2016 that the said Identification
Card could not be found, and it is my belief that the same could have fallen
somewhere while I was riding the Ceres bus or tricycle going to or from our
residence, or have just been misplaced;

3. That as all efforts to find the same proved unrewarding, it is now safe to conclude that
recovery of the same is an impossibility;

4. Thus, I execute this affidavit to establish its loss and to support my application for the
issuance of a new SSS Identification Card.

IN WITNESS WHEREOF, I have hereunto set my hand this 18th day of February 2017
at Tagbilaran City, Bohol, Philippines.

JENNIFER BERMOY HAMBRE


Affiant
VIN: 1230-0015B-F2079JBH20000

SUBSCRIBED AND SWORN TO before me this 18 th day of February 2017 in the City
of Tagbilaran, Bohol, Philippines, affiant exhibited to me her competent proof of identity
previously written.

WITNESS MY HAND AND SEAL.

Doc No: ________;


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

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