REPUBLIC OF THE PHILIPPINES )

CALOOCAN CITY ) S.S.

AFFIDAVIT

I, MANUEL PEDRO, of legal age, Filipino citizen, married and presently

residing at Bagong Silang, Caloocan city, Philippines, after having been duly
sworn to in accordance with law, depose and state:

1. That I am a member of the Social Security System (SSS) with SSS I.D.
No. -----------------.

2. That in year 1978, I registered with the SSS as self-employed

individual. However, the public utility jeep that I was supposed to
drive and operate sustained great damage during an accident. I only
drove the jeepney for less than a month and was forced to stop
because of said accident. As a result, I was not able to pay SSS
contribution as a self-employed individual. Eventually, I looked for
another job and was employed by a company and ceased to be self-
employed. From then on, I paid my SSS contributions as an employed
individual.

3. That I am executing this affidavit in truth to serve as an explanation,

to attest to the truth of the foregoing facts and for all legal purposes it
may serve.

IN WITNESS WHEREOF, I have hereunto set my hand 11 th day of

September, 2017 in Caloocan City, Philippines.

MANUEL PEDRO
Affiant

SUBCRIBED AND SWORN TO before me this 11th day of September,

2017 in Caloocan City, Philippines, affiant exhibiting to me his valid proof of
identification by way of Professional Drivers License No. N02-___________.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2017.