AFFIDAVIT OF DENIAL OF CRIMINAL CHARGE

REPUBLIC OF THE PHILIPPINES )

_____________________________ ) SS.

I, (name of affiant), Filipino, of legal age, single/married to (name of spouse), and a

resident of (address of affiant), after having been duly sworn in accordance with law,
hereby depose and say:
That I am NOT the same person as one a.k.a. who was charged under I.S. No._ / Criminal
Case No._ before the _ for the crime of _;
That I have never been the subject of any criminal complaint, charge or proceeding before
any prosecutor or court;
As such, I am executing this Affidavit to certify or attest to the truth of the foregoing facts
and for purpose of denying that I am the_ who is the subject of the aforementioned case
and for whatever legal purpose that this Affidavit may serve.
Further Affiant sayeth none.
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: (ID type and number),
valid from (date) to (date) issued by (issuing authority), 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 2010.