Republic of the Philippines

CITY OF CAGAYAN DE ORO

)
) S. S.

AFFIDAVIT OF DENIAL
I, JAMES P. ROMY, of legal age, single, Filipino and a resident of Cogon,
Balingsag, Misamis Oriental, after having been sworn to an oath in accordance with law
hereby depose and say:

1. That I went to the Office of the National Bureau of Investigation, Region X,

Cagayan de Oro City to apply/secure for NBI clearance;

2. That upon verification of the records, it appeared thereon and I was informed
that said Office could not issue the required clearance in view of the
appearance of name similar to my name in NBI files involving case/s filed
against said person bearing names similar to mine;

3. 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;

4. That in view of the foregoing, I am requesting the NBI Office to issue the
appropriate clearance in my favor for compliance with a certain requirements.
IN WITNESS WHEREOF, I have hereunto affixed my signature this 17 th day of
October, 2013, in the City of Cagayan de Oro, Philippines.

JAMES P. ROMY
Affiant
SUBSCRIBED AND SWORN TO before me this 17th day of October, 2013, in the
City of Cagayan de Oro, Philippines. Affiant exhibited to me his
_________________________ issued on ___________ issued at __________ as his
competent evidence of identity.
Doc. No.
_________;
Page No.
_________;
Book No.
_________;
Series of 2013.

NOTARY PUBLIC