Republic of the Philippines)

In the City of Davao )s.s.X ----------------------------------- x

AFFIDAVIT OF No - OPERATION I, _______________________________, of legal age, single/married, Filipino and a resident of Davao City, after having been duly sworn to in accordance with law, do hereby depose and say, THAT:1. I am the bonafide holder/owner of a UTILITY VEHICLE bearing the Plate Number _____________________;2. That from the period of June to August of 2012, the assigned driver, ___________________ went to Bohol;3. That because of the above-stated reason, the above described utility vehicle stopped its operation;4. That I am executing this affidavit to attest to the truth of the foregoing facts and to apprise the Office of the SSS of the same and for whatever legal purpose this may serve best.

IN WITNESS WHEREOF, I have hereunto set my hand this _______________________, at Davao City, Philippines._____________________Affiant

Competent Proof of Identity:

SSS ID No. ________________With Conformity:

_________________

DriverSUBSCRIBED AND SWORN TO before me this _____________________, at Davao City, Philippines. Affiant executed to me his competent proof of identity as shown above.Doc. No. _____;

Page No._____;

Book No. _____;

Series of 2013.