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    Affidavit of Loss

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    leslie ann rase
    1) Evelyn Gemina applied for a maternity benefit from the Social Security System in 2013 and was required to complete a Maternity Notification Form. 2) She has since discovered that the Maternity Notification Form is missing and despite searching, she has been unable to find it. 3) She is executing this affidavit to attest that the form is lost and to allow her to reapply for the maternity benefit from SSS.

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    Affidavit of Loss

    Uploaded by

    leslie ann rase
    35 views2 pages
    1) Evelyn Gemina applied for a maternity benefit from the Social Security System in 2013 and was required to complete a Maternity Notification Form. 2) She has since discovered that the Maternity Notification Form is missing and despite searching, she has been unable to find it. 3) She is executing this affidavit to attest that the form is lost and to allow her to reapply for the maternity benefit from SSS.

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    1) Evelyn Gemina applied for a maternity benefit from the Social Security System in 2013 and was required to complete a Maternity Notification Form. 2) She has since discovered that the Maternity Notification Form is missing and despite searching, she has been unable to find it. 3) She is executing this affidavit to attest that the form is lost and to allow her to reapply for the maternity benefit from SSS.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    35 views2 pages

    Affidavit of Loss

    Uploaded by

    leslie ann rase
    1) Evelyn Gemina applied for a maternity benefit from the Social Security System in 2013 and was required to complete a Maternity Notification Form. 2) She has since discovered that the Maternity Notification Form is missing and despite searching, she has been unable to find it. 3) She is executing this affidavit to attest that the form is lost and to allow her to reapply for the maternity benefit from SSS.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 2

    REPUBLIC OF THE PHILIPPINES)

    CITY OF ILOILO ) S.S.


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

    AFFIDAVIT OF LOSS

    I, EVELYN GEMINA, of legal age, Filipino, married, and a resident


    of Brgy. Bulad, Guimbal, Iloilo, Philippines, after having been duly sworn
    to in accordance with law hereby voluntarily depose and say that:

    1. Last 2013, I applied for a Maternity Benefit before the Social Security
    System (SSS) Iloilo Branch;

    2. By virtue of such application, I was required to accomplish the


    Maternity Notification Form;

    3. However, sometime last month, I discovered that the said Maternity


    Notification Form is no longer in the place where I usually keep the
    same;

    4. Despite my diligent search and efforts, I cannot find the said Maternity
    Notification Form;

    5. Henceforth, I consider it as lost and beyond recovery;

    6. I am executing this affidavit to the truthfulness of the foregoing. This


    Affidavit attests for the purpose of allowing me to apply for the afore-
    mentioned benefit in the SSS.

    IN WITNESS WHEREOF, I have hereunto set my hand this


    _______________ in the City of Iloilo, Philippines.

    EVELYN GEMINA
    Affiant
    UMID ID No. CRN-0111-0056331-0

    The affiant, whose name and personal circumstances are stated


    above, personally appeared before me this _______ in the City of Iloilo,
    Philippines, presented the foregoing affidavit, signed the same in my
    presence and affirmed under oath to the correctness of the contents or
    allegations of the same.
    The affiant was identified by competent evidence of identity
    appearing below his name.

    Doc. No. ___;


    Page No. ___;
    Book No. ___;
    Series of 2021.

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