REPUBLIC OF THE PHILIPPINES)

CITY OF MAKATI ) S.S.

x-------------------------------------x

AFFIDAVIT OF DENIAL

I, ___________________, of legal age, Filipino,

(single/married/widow) and a resident of
_______________________________, after having been duly sworn to in
accordance with law, depose and state:

1. That I was born on ________________ in

__________________________;

2. That I established my permanent residence in __________________,

Philippines;

3. That on ___________________, I applied for a Record Clearance from

the National Bureau of Investigation;

4. That I received an information from the National Bureau of Investigation

on ______________ that my namesake,
a certain _______________________, has a pending criminal case for
Attempted Homicide docketed as Criminal Case No. 1234 pending
before Branch 67 of the Metropolitan Trial Court of Quezon City;

5. That I hereby unequivocally deny involvement in the aforementioned

case;

6. That I also declare under oath that I am not in any way involved in any
case proceeding as either plaintiff/complainant or defendant/accused in the
Philippines and abroad, specifically with regard to the aforementioned case;

7. That I have been employed or residing in Hong Kong for ________ years
to this date;

8.That ___________________________________________________
(cite other proof/s or reason/s to substantiate your claim that you are not
involved in the aforementioned case/s, if any); and

9. That I am executing this Affidavit to attest to the foregoing facts and to

deny absolutely and entirely any involvement in the case/s aforementioned
and for all legal intents and purposes.
 IN WITNESS WHEREOF, I hereby affixed my signature
this ___________________ in MakatiCity, Metro Manila, Philippines.

_______________

Affiant

SUBCRIBED AND SWORN TO before me this _____________ in

______________, Philippines, affiant exhibiting to me his/her competent
evidence of identity by way of ______________ issued at _____________
on ______________.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2013.
Republic of the Philippines)
Province of _________________)S.S.
City/Municipality of ____________)
x---------x

AFFIDAVIT OF DENIAL
I,_____________, Filipino, of legal age,(single / married / widow), and as
resident of____________, Philippines, having been duly sworn in
accordance with law, hereby depose and state:

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.

IN WITNESS WHEREOF, we have set our hands this__________, in the

City of____________, Philippines.

(JURAT)
REPUBLIC OF THE PHILIPPINES)Province of____________________)
S.S.City/Municipality of_____________)x---------------------------------------x

AFFIDAVIT OF DENIAL for NBI CLEARANCE

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 deposeand state:1. That the NBI Main Office in Taft Ave., Manila has
advised me that said Office could notissue the required clearance in view of the appearance of name
similar to my name inNBI files involving in case/s filed against said person bearing names similar to
mine;2. That I am NOT the same person as
one __________________ a.k.a. _________ whowas charged under I.S. No. ________ / Criminal Cas
e No. ______ before the __________________________ for the crime of __________ ;3. That my
middle name is ________________ and
not _____________ .4. That I am executing this affidavit to attest to the foregoing facts and to denyc
ategorically and specifically under oath that I am not the same person mentioned in thedocket/files
of NBI with the said derogatory/civil/criminal record/s;In view of the foregoing, I am requesting NBI
Main Office in Taft Avenue, Manila to issue theappropriate NBI clearance in my favor.IN WITNESS
WHEREOF, I have hereunto affixed my signature this ____ th day
of ____________ 20 ___ at ____________ ,
Philippines. _________________________________ (Signature of Affiant over Printed Name)

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in and for _________(City/Province)____
________ this ____ th day
of ____________ 20 ___ .Affiant personally came and appeared with _____________(Competent Ev
idence of Identity)______ issued by
the _________(Government Agency)______ on ___(date)__ at ________(place)_________ , bearing
his photograph and signature, known to me as thesame person who personally signed the foregoing
instrument before me and avowedunder penalty of law to the whole truth of the contents of
said instrument.Atty ___________________________________________ Notary PublicDoc.
No. ____ Commission Serial No. ____________________________ Page No. ____ Notary Public
for _______(Province/City)______________ Book No. ____ Until December 31, 20 __ Series of
20 __ Office: ______________(address)____________________ Roll No.

__________