REPUBLIC OF THE PHILIPPINES)

CITY O F __________ ) SS.

AFFIDAVIT OF NO EARNINGS
FROM SELF-EMPLOYED

I, ______________, of legal age, Filipino, married and a resident of

_____________________, under oath state THAT:

1. I am not gainfully employed and thus, I only generate minimal income

enough for me and my family’s sustenance;

2. I am not currently employed with any person, natural or juridical, and I

have not been gainfully employed;

3. My husband ____________ is presently employed as a company

driver/salesman and is earning a minimum wage;

4. I am executing this Affidavit to attest to the truth of the foregoing

narration of facts and for my SSS retirement benefit claim and for
whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this

_______________________ at __________, Philippines.

_________________
Affiant

SUBSCRIBED AND SWORN to before me this _________________ at

Davao City, Philippines, affiant exhibiting to me her Social Security System ID
No. 0363706902 as her competent evidence of identity.

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2015.