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 Makati City, 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.