Social Security System
Social Security System
Social Security System
AFFIDAVIT
I, AMIE D.S. DELA CRUZ of legal age, Filipino, single and a resident of, #25 Purok
2, Brgy. Mabuhay, Talavera, Nueva Ecija, after having been sworn to in accordance with
law, hereby depose and state the following:
2. That AMIE D.S. DELA CRUZ with the following signature stroke as appearing in
the Scholarship Training Voucher and Daily Attendance Sheet to wit: supply
and AMIE D.S. DELA CRUZ with the following signature stroke as appearing in
the Assessment Attendance Sheet to wit:
3. That I am executing this Affidavit to attest to the truthfulness of this fact and for
whatever legal purposes it may serve.
IN WITNESS WHEREOF, WE have hereunto affixed our signature this ____ day of
_____________________________ at Cabanatuan City. Fill out
SUBSCRIBED AND SWORN to before me at the place and date above stated. I
hereby certify that I personally examined the affiant and am convinced that she voluntarily
executed the foregoing affidavit, read the same and understood its contents.
AFFIDAVIT
WE, SPS. BENITO A. DELA CRUZ and CRESENCIA H. DELA CRUZ of legal
ages, Filipinos, and residents of #202 Brgy. Lourdes, Sta. Rosa, Nueva Ecija, after having
been sworn to in accordance with law, hereby depose and state the following:
5. That we are executing this Affidavit to attest to the truthfulness of this fact and
to support our proposal to buy with DAN REY BRIONES and for any legal
purposes it may serve.
IN WITNESS WHEREOF, WE have hereunto affixed our signature this ____ day of
_____________________________ at Cabanatuan City.
SUBSCRIBED AND SWORN to before me at the place and date above stated. I
hereby certify that I personally examined the affiants and am convinced that they
voluntarily executed the foregoing affidavit, read the same and understood its contents.
AFFIDAVIT OF EXPLANATION
I, GLORIA B. GUINTO, of legal age, Filipino, and a resident of Sto. Cristo Sur,
Gapan, Nueva Ecija, after having been sworn to in accordance with law, hereby depose
and state the following:
8. That during the months of April and May 2016 and 2017, our employees have
no earnings because of the students’ vacation (as per their contract of
employment from June to March), thus, the school does not pay its monthly
premiums during the said period;
9. That I admit it is my fault and negligence I did not report with the SSS that our
employees have no earnings during the said periods and I would like to
apologize for my mistake to the SSS;
10. That this Affidavit is to attest to the truthfulness of this fact and to support my
request with the Social Security System to accept my apology and for any legal
purpose it may serve.
GLORIA B. GUINTO
Affiant
TIN: 219-846-456
SUBSCRIBED AND SWORN to before me at the place and date above stated. I
hereby certify that I personally examined the affiant and am convinced that she voluntarily
executed the foregoing affidavit, read the same and understood its contents.
AFFIDAVIT OF EXPLANATION
13. That during the months of March, April and May 2011, our employees has no
earnings because of the student’s vacation, thus, the school does not pay its
monthly premiums during the said period;
14. That also in November, 2011 to May, 2012, the school cannot pay its monthly
contribution with the SSS because the school suffered financial losses during
that time and our employees was not able to pay their salaries;
15. That starting on January, 2013 the school continue to suffered financial losses
that results us to close our school until the present time, hence we have no
more employees/teacher and we also did not pay the monthly contributions
with the SSS;
16. That I admit it is my fault and negligence I did not report with the SSS that our
employees has no earnings during the said periods and I would like to
apologize for my mistake to the SSS;
17. That this Affidavit is to attest to the truthfulness of this fact and to support our
request with the Social Security System to accept my apology and for any legal
purpose it may serve.
GLENDA O. PASCUAL
Affiant
SSS No. 02-21303997
SUBSCRIBED AND SWORN to before me at the place and date above stated. I
hereby certify that I personally examined the affiant and am convinced that she voluntarily
executed the foregoing affidavit, read the same and understood its contents.
AFFIDAVIT OF EXPLANATION
20. That during the months of March, April and May 2011, our employees has no
earnings because of the student’s vacation, thus, the school does not pay its
monthly premiums during the said period;
21. That also in November, 2011 to May, 2012, the school cannot pay its monthly
contribution with the SSS because the school suffered financial losses during
that time and our employees was not able to pay their salaries;
22. That starting on January, 2013 the school continue to suffered financial losses
that results us to close our school until the present time, hence we have no
more employees/teacher and we also did not pay the monthly contributions
with the SSS;
23. That I admit it is my fault and negligence I did not report with the SSS that our
employees has no earnings during the said periods and I would like to
apologize for my mistake to the SSS;
24. That this Affidavit is to attest to the truthfulness of this fact and to support our
request with the Social Security System to accept my apology and for any legal
purpose it may serve.
SUBSCRIBED AND SWORN to before me at the place and date above stated. I
hereby certify that I personally examined the affiant and am convinced that she voluntarily
executed the foregoing affidavit, read the same and understood its contents.
AFFIDAVIT OF LOSS
I, GERARDO M. REYES, of legal age, Filipino, and a resident of Kapt. Pepe Subd.
Cabanatuan City, Nueva Ecija, after having been sworn to in accordance with law, hereby
depose and state the following:
25. That I am a member/contributor of Social Security Syatem with SSS No. 02-
1189631-7;
29. That this Affidavit is to attest to the truthfulness of this fact and to support my
request with the Social Security System to update my contribution and for any
legal purpose it may serve.
GERARDO M. REYES
Affiant
SSS No. 02-1189631-7
SUBSCRIBED AND SWORN to before me at the place and date above stated. I hereby
certify that I personally examined the affiant and am convinced that he voluntarily executed
the foregoing affidavit, read the same and understood its contents.
AFFIDAVIT OF EXPLANATION
I, GLENDA O. PASCUAL, of legal age, Filipino, and a resident of Talabutab Norte, Gen.
Natividad, Nueva Ecija, after having been sworn to in accordance with law, hereby depose and
state the following:
31. That UNITED METHODIST CHURCH CITY TEMPLE in Cabanatuan City has an
employer ID No. 02-0498600-1 with the Social Security System (SSS) and paying
its Contribution regularly to the SSS Cabanatuan ;
32. That JULIET TEJADA PASCUA with SSS No. 08-0909820-0 is an employee of
UNITED METHODIST CHURCH CITY TEMPLE since June 2013 up to present and
her monthly contribution to SSS was regularly remitted to SSS as per SSS
Employer Contributions Payment Return (R-5);
33. That UMCT submits the SSS Contribution Collection List (R3) regularly to SSS,
however, upon application for loan of Ms. Juliet Pascua, we found out that her SSS
No. was inadvertently reported as SSS No. 02-0909820-8 instead of 08-0909820-0
from June 2013 to May 2014;
34. That this Affidavit is to attest to the truthfulness of this fact and to support our
request with the Social Security System to update the contribution of JULIET
TEJADA PASCUA and for any legal purpose it may serve.
GLENDA O. PASCUAL
Affiant
SSS No. 02-21303997
SUBSCRIBED AND SWORN to before me at the place and date above stated. I hereby
certify that I personally examined the affiant and am convinced that she voluntarily executed
the foregoing affidavit, read the same and understood its contents.
Dear Madam;
Christian greetings!
We would like to inform your end that the our former employee of OUTREACH
PHILIPPINES INC. in Cabanatuan City, HONEY ROCEHL V. SAPITAN with
SSS No. 02-2388077-7, resigned from OUTREACH PHILIPPINES, INC. on
November 30, 2011 and is therefore no longer connected with us.
Hence, we are requesting your end to delete her name, HONEY ROCEHL V.
SAPITAN from the list of employees of OUTREACH PHILIPPINES INC. for SSS
purposes effective on the date of her resignation on November 30, 2011.
EMILY E. GARUBO
Administrative Officer, OUTREACH PHILIPPINES INC.
SSS Employer ID No. 02-0917596-9
I, EMILY E. GARUBO, of legal age, Filipino, the Administrative Officer of the OUTREACH
PHILIPPINES INC. with an office address at 630 Sampaguita St., Milbuena Subd. Magsaysay
Sur, Cabanatuan City , after having been sworn to in accordance with law, hereby depose and
state the following:
36. That OUTREACH PHILIPPINES INC. in Cabanatuan City has an employer ID No. 02-
0917596-9 with the Social Security System (SSS);
EMILY E. GARUBO
Affiant
SSS No. 02-0649934-7
SUBSCRIBED AND SWORN to before me at the place and date above stated. I hereby
certify that I personally examined the affiant and am convinced that she voluntarily executed
the foregoing affidavit, read the same and understood its contents.
Dear Madam;
Christian greetings!
We would like to inform your end that the our former employee of OUTREACH
PHILIPPINES INC. in Cabanatuan City, HONEY ROCEHL V. SAPITAN with
SSS No. 02-2388077-7, resigned from OUTREACH PHILIPPINES, INC. on
November 30, 2011 and is therefore no longer connected with us.
Hence, we are requesting your end to delete her name, HONEY ROCEHL V.
SAPITAN from the list of employees of OUTREACH PHILIPPINES INC. for SSS
purposes effective on the date of her resignation on November 30, 2011.
EMILY E. GARUBO
Administrative Officer, OUTREACH PHILIPPINES INC.
SSS Employer ID No. 02-0917596-9
I, NOEL B. SANTIAGO, of legal age, Filipino, the Administrative Pastor of the UNITED
METHODIST CITY TEMPLE with an office address Corner Santiago and Del Pilar Street,
Cabanatuan City , after having been sworn to in accordance with law, hereby depose and state
the following:
40. That UNITED METHODIST CHURCH CITY TEMPLE in Cabanatuan City has an
employer ID No. 02-0498600-1 with the Social Security System (SSS);
43. That this Affidavit is to attest to the truthfulness of this fact and to support our
request with the Social Security System to delete their names, AURORA R.
PAJARILLAGA, GLORIA C. REYES, GUILLERMA V. ANGELES, and EUFROCINA P.
PRONTO from the list of employees of UNITED METHODIST CHURCH CITY
TEMPLE in Cabanatuan City for SSS purposes effective on the respective dates of
their resignation and for any legal purpose it may serve.
NOEL B. SANTIAGO
Affiant
SSS No. ___________________
SUBSCRIBED AND SWORN to before me at the place and date above stated. I hereby
certify that I personally examined the affiant and am convinced that he voluntarily executed
the foregoing affidavit, read the same and understood its contents.
Dear Madam;
Christian greetings!
We would like to inform your end that the following former employees of UNITED
METHODIST CHURCH CITY TEMPLE in Cabanatuan City, AURORA R. PAJARILLAGA and
GLORIA C. REYES, resigned on June 1, 2002, and GUILLERMA V. ANGELES, resigned on June 1,
2010 and are no longer connected with us and EUFROCINA P. PRONTO did not become our
employee/worker and is also not connected with us.
Hence, we are requesting your end to delete their names, AURORA R. PAJARILLAGA,
GLORIA C. REYES, GUILLERMA V. ANGELES, and EUFROCINA P. PRONTO, from the list of
employees of METHODIST CHURCH CITY TEMPLE for SSS purposes effective on the
respective dates of their resignation.
NOEL B. SANTIAGO
Authorized Representative, UNITED METHODIST CHURCH CITY TEMPLE
SSS Employer ID No. 02-0498600-1
2. That MYLENE G. GAMBITO is separated de facto from her husband and has
one daughter;
3. That MYLENE G. GAMBITO and her daughter are living with her parents and
are dependent on them on everything including the education of her daughter;
5. That this Affidavit is to attest to the truthfulness of this fact and for any other
legal intents and purposes this may serve.
SUBSCRIBED AND SWORN to before me at the place and date above stated. I
hereby certify that I personally examined the affiant and am convinced that they voluntarily
executed the foregoing affidavit, read the same and understood its contents.
1. That I am a holder of Philam Plans Inc. Insurance under Plan No. 3270108401;
2. That I have already fully paid my said Insurance Plan No. 3270108401 with
Philam Plans Inc. in November 2007;
3. That I have not received yet my Certificate of Full Payment for my Insurance
Plan No. 3270108401;
4. That this Affidavit is to attest to the truthfulness of this fact and to support my
request with the Philam Plans Inc. to issue my Certificate of Full Payment.
JERRY M. OBEDOZA
Affiant
SUBSCRIBED AND SWORN to before me at the place and date above stated. I
hereby certify that I personally examined the affiant and am convinced that he voluntarily
executed the foregoing affidavit, read the same and understood its contents.
8. That this Affidavit is to attest to the truthfulness of this fact and to support my
request with the Social Security System to issue my SSS ID Card.
SUBSCRIBED AND SWORN to before me at the place and date above stated. I
hereby certify that I personally examined the affiant and am convinced that she voluntarily
executed the foregoing affidavit, read the same and understood its contents.
AFFIDAVIT OF NO BUSINESS
2. That I do not have any other business except my employment at GMA Network,
Inc., Manila since September 2007 ;
3. That this Affidavit is to attest to the truthfulness of this fact for any legal
purposes it may serve.
SUBSCRIBED AND SWORN to before me at the place and date above stated. I
hereby certify that I personally examined the affiant and am convinced that he voluntarily
executed the foregoing affidavit, read the same and understood its contents.
4. That this Affidavit is to attest to the truthfulness of this fact and to support our
request with the Social Security System to delete their names, MARIO S.
PADILLA, HERMOGENES LISONDRA JR., and EMALIN C. LANGRES,
from the list of employees of OUTREACH PHILIPPINES INC. in connection
with SSS purposes effective on the respective dates of their resignation and for
any legal purpose it may serve.
IN WITNESS WHEREOF, I have hereunto affixed my signature this 5th day of
May, 2011 at Cabanatuan City.
EMILY E. GARUBO
Affiant
SSS No. 02-0649934-7
SUBSCRIBED AND SWORN to before me at the place and date above stated. I
hereby certify that I personally examined the affiant and am convinced that she voluntarily
executed the foregoing affidavit, read the same and understood its contents.
May 5, 2011
Dear Madam;
Christian greetings!
We would like to inform your end that the following former employees of OUTREACH
PHILIPPINES INC., MARIO S. PADILLA, HERMOGENES LISONDRA JR., and
EMALIN C. LANGRES resigned respectively on April 30, 2007, May 31, 2007 and May
31, 2009, and are no longer connected with us.
Hence, we are requesting your end to delete their names, MARIO S. PADILLA,
HERMOGENES LISONDRA JR., and EMALIN C. LANGRES, from the list of employees
of OUTREACH PHILIPPINES INC. in connection with SSS purposes effective on the
respective dates of their resignation.
EMILY E. GARUBO
Authorized Representative, Outreach Philippines Inc.
SSS Employer ID No. 02-0917596-9
REPUBLIC OF THE PHILIPPINES )
CITY OF CABANATUAN ) S.S.
AFFIDAVIT OF NON-EMPLOYED
I, MA. CRISTINA C. BAO, of legal age, Filipino and a resident of Quezon St., Pob.
Sur, Rizal, Nueva Ecija, after having been sworn to in accordance with law, hereby depose
and state the following:
5. That I was born in Cabanatuan City to the Spouses Rolando D. Bao, Sr. and
Virginia G. Cadapan on December 8, 1981;
11. That this Affidavit is to attest to the truthfulness of this fact and to support for
my petition for change of first name as a non-employed individual.
AFFIDAVIT OF NON-EMPLOYMENT
I, FELIPE G. DAYAO, of legal age, Filipino and a resident of Sta. Barbarra, San
Antonio, Nueva Ecija, after having been sworn to in accordance with law, hereby depose
and state the following:
6. That I am the legal husband of late Aida R. Dayao as per attached Certificate of
Marriage from the National Statistic Office (NSO);
7. That Aida R. Dayao my wife died last December 03, 2009 as per attached
Death Certificate from the National Statistic Office (NSO);
8. That I am unemployed and does not receive or earn a regular income and is not
a member of Social Security System (SSS);
9. That this Affidavit is to attest to the truthfulness of this fact and to support my
benefits claim from Government Service Insurance System (GSIS) as a legal
beneficiary.
FELIPE G. DAYAO
Affiant
ID/CTC No. ____________
Issued on ______________
at ____________________
SUBSCRIBED AND SWORN to before me at the place and date above stated with
affiant exhibiting to me his Community Tax Certificate indicated below his name. I hereby
certify that I personally examined the affiant and am convinced that he voluntarily executed
the foregoing affidavit, read the same and understood its contents.