Republic of the Philippines

Camiling, Tarlac

)
) S.S.

AFFIDAVIT OF NO EARNINGS
I, FELITICIA ARGALES y DURAN, 60 years old, Filipino
citizen, married, and a resident of Barangay Bacabac, Camiling,
Tarlac, Philippines, after having been duly sworn to in accordance
with law, do hereby depose and state THAT:
1. I became a member of the Social Security System (SSS)
when I was engaged in odd jobs;
2. However, starting October 1, 2015, due to failing health
condition and old age, I ceased to work as an odd job
person and did not engage in any gainful occupation up to
present;
3. I am executing this affidavit in support of my Retirement
Claim Benefit from the SSS;
4. Finally, I am executing this affidavit to attest to the truth of
the foregoing statements and for all legal intents and
purposes it may serve.
IN WITNESS WHEREOF, I hereunto affixed my signature this
5 day of January, 2017 at Camiling, Tarlac, Philippines.
th

FELITICIA D. ARGALES
Affiant
SUBSCRIBED AND SWORN to before me on the date and
place indicated above. Affiant exhibited before me her SSS ID Card
with SS No. 33-2416878-0 issued by the Social Security System of
the Philippines.

Doc. No. _____;

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