Affidavit of Denial (NBI)

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REPUBLIC OF THE PHILIPPINES)

_________________________)

AFFIDAVIT OF DENIAL
 
            I, ________________________________, Filipino citizen, of legal age,
single/married/widow/widower, and a resident of
_______________________________, after having been duly sworn in accordance with
law, hereby depose and say:
 
1. That while on the process of securing my NBI Clearance, it appeared in their
record that a certain ___________________ reported by _________________ for
alleged violation of ________________ at ____________________ on
_______________;

2. That I categorically state that I am NOT the same _____________________ who


was charged of the above-captioned case as I have never been charged for any
criminal, civil or administrative offense anywhere in the Philippines and particularly
at __________________; and,

3. That I am executing this affidavit in order to attest to the truth of that I have not
been charged of any offense, whatsoever, and that I am not the same
_____________________ who has previous records or charges in Court or in any
governmental agencies, and for all legal intents and purposes it may serve. 

            IN WITNESS WHEREOF, I have hereunto affixed my signature this


_________________, ___________________Philippines.

 
____________________________
Affiant
ID NO.____________________

 
SUBSCRIBED AND SWORN before me this ________________ at
___________________. Affiant exhibited to me his/her identification document
indicated below his/her name.

 WITNESS MY HAND and NOTARIAL SEAL at date and place above written.

Doc. No. ____;


Page No. ____;
Book No.____;
Series of ____.

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