Republic of the Philippines )

)
)

AFFIDAVIT OF NON-RECEIPT

I, WILFREDO C. PASCUAL, of legal age, single/married with residence and postal

address at NO. 1 NATIONAL HIGHWAY MAXINGAL LAL-LO, CAGAYAN-3509, after
having duly sworn to in accordance with law depose and state.

That I am a bonafide member of the Social Security System with SS No. 03-2091826-7.

That on DECEMBER 09, 2008, I filed with the SSS an application for RETIREMENT.

That verification with the SSS yielded that the application was duly approved and my
initial pension in the amount of P25,344.50 was paid in check and was sent to me thru mail.
However I did not received such check.

That said amount was not credited to my account as per verification from the bank.

That I am executing this document to attest to the foregoing facts and to support my
request for replacement.

That I will refund the total amount stated and submit myself to an investigation and / or
criminal prosecution in the event that the foregoing representations turn out to be false.

IN TESTIMONY HEREOF, I have hereunto affixed my signature this 8th day of

JANUARY, 2019 at TUGUEGARAO CITY, CAGAYAN, Philippines.

_______________________
(Affiant)
TIN 131-879-885

SUBSCRIBED AND SWORN to before me this 8th day of JANUARY 2019, affiant
WILFREDO C. PASCUAL exhibited to me his / her Residence Certificate No. 12134672
issued on JANUARY 8, 2019 at TUGUEGARAO CITY, CAGAYAN.

________________________
(Notary Public)

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