REPUBLIC OF THE PHILIPPINES . . . )PROVINCE OF DAVAO DEL NORTE)S.S CITY OF TAGUM . . . . . . . . . . . . . . . . . )X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X

AFFIDAVIT

I, MARILYN CALIMUTAN , of legal age, Filipino , single and a resident of Seminary Drive, Magugpo West, Tagum City, Davao del Norte , Philippines, after having been duly sworn to in accordance with law do hereby depose and say;

1. That I the same person affiant of this affidavit likewise a member of Social Security System (SSS);

2. That I was issued an SSS ID Card for Self Employed Member and on 1992-1995 I was employed at Plateria Rose Gold Pawnshop at Davao City, unknown to me, my employer applied for my SSS ID (Private Employee);

3. That recently I discovered that I have two (2) SSS number for Self-employed and for Private Employee;

4. That I have already surrendered my SSS ID Card (Self-employed) at SSS Davao City;

5. That I am executing this affidavit to inform the authorities concerned on the veracity of the foregoing facts and for whatever legal purpose it may serve.IN WITNESS WHEREOF, I have hereunto set my hand this 10th day of July 2014 at Tagum City, Davao del Norte, Philippines.

MARILYN CALIMUTAN Affiant

SUBSCRIBED AND SWORN to before me this 10th day of July 2014. At Tagum City, Philippines. Affiants exhibit her PhilHealth Card bearing no. 16-035493125-7 issued by the Philippine Health Insurance Corporation.Doc. No.:_________Page No. _________Book No._________Series of 2013