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REPUBLIC OF THE PHILIPPINES} PUERTO PRINCESA CITY } S.S.

AFFIDAVIT OF LOSS KNOW ALL MEN BY THESE PRESENTS: I, PERLITA P. GRAVADOR, of legal age, single, Filipino and presently residing at Tanigue Street, Barangay Mandaragat, Puerto Princesa City, after having been sworn to an oath do hereby depose and state, THAT: 1. I am member of the Social Security System (SSS) and as such was issued Identification Card No. I.D. No. 09-1239490-1; 2. Two (2) years when still working in Singapore, I carried with me my said SSS ID; 3. While thereat, I usually place my said I.D. at my drawer in my room; 4. During one time when I was to retrieve said I.D. at my drawer, the same could not be located; 5. I tried to search the said I.D. in all places where it could possibly be placed but the same could no longer be found, and is now considered lost. 6. I am executing this affidavit of loss to attest to the truth of the foregoing and for the purpose of requesting the Social Security System to issue me a new SSS I.D. in replacement thereof. IN WITNESS WHEREOF, I have hereunto signed this affidavit of loss this 31st day of October 2007 in Puerto Princesa City, Palawan.

PERLITA P. GRAVADOR Affiant SUBSCRIBED and SWORN to before me this 31 st day of October 2007 at Puerto Princesa City, Palawan, affiant personally appeared and exhibited to me her Community Tax Certificate No. 03136151, issued on January 19, 2007 at Puerto Princesa City, Palawan. WITNESS MY HAND AND SEAL on the date and place above written.

ATTY. FREDERICK F. ABUEG Notary Public Until December 31, 2008 Roll No. 51242, May 6, 2006 PTR No. 0111201, Jan.23, 2007 Puerto Princesa City, Palawan IBP No. 713535, April 10, 2007 IBP Palawan Chapter Doc. No. ___ Page No. ___ Book No. I Series of 2007

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