AFFIDAVIT OF DENIAL

REPUBLIC OF THE PHILIPPINES )

_____________________________ ) SS.
I, _____________________________, Filipino, of legal age, single/married
to _____________________________, and a resident
of _____________________________, after having been duly sworn in accordance
with law, hereby depose and say:
1. That the NBI Office in Manila has advised me that said Office could not issue the
required clearance in view of the appearance of name similar to my name in NBI files
involving in case/s filed against said person bearing names similar to mine;
2. That I am executing this affidavit to attest to the foregoing facts and to deny
categorically and specifically under oath that I am not the same person mentioned in
the docket/files of NBI with the said derogatory/civil/criminal record/s;
In view of the foregoing, I am requesting NBI Office to issue the appropriate police
clearance in my favor for compliance with the certain requirements.
IN WITNESS WHEREOF, I have hereunto affixed my signature this ____ day of
____________ 20___ at ________________________, Philippines.
______________________________________
(Signature of Affiant over Printed Name)
SUBSCRIBED AND SWORN TO before me, a notary public in and for
_____________________ this ____ day of ____________ 20___. The affiant, whom
I identified through the following competent evidence of
identity: _____________________________, valid from __________________
to __________________ issued by _____________________________, personally
signed the foregoing instrument before me and avowed under penalty of law to the
whole truth of the contents of said instrument.

Notary Public
Doc. No. ........;
Page No. .......;
Book No. .......;
Series of 20___.