REPUBLIC OF THE PHILIPPINES)

QUEZON CITY, METRO MANILA ) S.S.

AF F I D AV I T O F LO S S
I, ANNA MARIE I. TANSIP, of legal age, Filipino and a resident of #73 Brixton Hill
St. Araneta Ave. Quezon City, having been duly sworn to in accordance with law do hereby
depose and say:
1. That I am a holder and a user of Smart SIM Card with card number 09205388376
issued to me by Smart Tell.
2. That I am selling electronic load using my mobile phone and the above mentioned
Sim Card;
3. That on December 02, 2006 while looking for the said SIM to sell electronic load I
discovered that my SIM Card issued to me by Smart Tell was missing;
4. That wish to declare and manifest that the said Sim Card was not indorsed nor
entrusted to anybody but simply misplaced and considered lost:
5. That despite of my diligent effort the said Smart Sim Card was not recovered and
considered lost.
6. That I have executed this affidavit to attest to the truth of all the foregoing and to
satisfy the inquiry or requirements of any person or office and for other legal purpose
it may serve.
FURTHER, AFFIANT SAYETH NAUGHT.

ANNA MARIE I. TANSIP

Affiant
SUBSCRIBED AND SWORN to before me this 4h day of November, 2006 in Quezon
City, affiant exhibited to me her Postal I.D _______________ issued by _______________.

Doc. No. ________:

Page No. ________:
Book No. ________:
Series of 2006.

Notary Public

REPUBLIC OF THE PHILIPPINES)

QUEZON CITY, METRO MANILA ) S.S.

AFFIDAVIT OF CHANGE OF STATUS

I, GLORILIE S. TUMAMPIL, of legal age, Filipino, married and a resident of #

0939 Upper Tagpos, Binangonan, Rizal, after having been duly sworn to in accordance
with law, hereby depose and say:
1. That I am a member
No.______________;

of

Social

Security

System

under

SSS

2. That in my SSS record my status is still single;

3. That on October 28, 1992, in Ibajay, Aklan I got married to one
Jenny C. Tumampil;
4. That for thirteen (13) years of our living together as husband and wife, we
were blessed with four (4) minor children namely:
Name
1. Jose Corazon S. Tumampil
2. John Frenz S. Tumampil
3. Jessica Felisa S. Tumampil
4. Joan Carla S. Tumampil

Birthdate
06-18-93
11-29-94
07-22-96
11-13-98

Age
12
10
9
6

5. That being married I wish to change my status from single to married;

6. That by this instrument, I wish to declare as my legal heirs and beneficiaries
in my SSS records, my above-mentioned four (4) minor children and my
husband, Jenny C. Tumampil;
7. That I have executed this affidavit to attest to the truth of all the foregoing to
satisfy the inquiry or requirements of any person or office particularly with the
Social Security System and for whatever legal purpose this may serve.
FURTHER, AFFIANT SAYETH NAUGHT.

GLORILIE S. TUMAMPIL
Affiant
SUBSCRIBED AND SWORN to before me this 24th day of May, 2005 in Quezon
City.

Doc. No.______:
Page No.______:
Book No.______:
Series of 2005.