Republic of the Philippines

Butuan City, Agusan del Norte ) S.S.

AFFIDAVIT

I, JO1 Reinald Raven L Guerrero, of legal age, Filipino, with permanent address at
Purok 2-a, Ampayon, Butuan City, Agusan del Norte , after having been duly sworn to in
accordance with law, hereby voluntarily depose and say:

1. I am currently employed as Jail Officer 1 in the Bureau of Jail Management

and Penology;

2. That I am applying for an Authority to Travel Abroad while on Leave of

Absence;

3. That there is no pending administrative or criminal case filed against me in

any forum;

4. That I am executing this affidavit to attest to the truth of the foregoing facts in
compliance with the requirements for approval of Authority to Travel Abroad while
on Leave of Absence.

IN WITNESS, HEREOF, I have set my hand and affixed my signature this _____day of
January, 2017 at Butuan City.

JO1 Reinald Raven L Guerrero

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this _______ day of _________

___________, 20 ______, affiant exhibited to me his/her Government Issued ID
__________with No._________________ issued at ____________________ on
____________________.

Doc. No. ________

Page No. ________
Book No. ________
Series of ________

NOTARY PUBLIC