REPUBLIC OF THE PHILIPPINES )

CITY OF ) S.S.
PROVINCE OF ________________________)

AFFIDAVIT OF NO PENDING CASE

I, DIOSDADO S. AGUSTIN, of legal age, Filipino, married, and a resident of Purok 1,

Barangay Anunas, Angeles City, after having been sworn to in accordance with law, hereby
depose and state:
1. That I have never been involved in any unlawful activities nor have been charged
administratively;

2. That I have never been found guilty/convicted of any administrative offense

and/or crime;

3. That there is no pending criminal investigation or prosecution against me;

4. That I am executing this affidavit in order to attest to the truth of the foregoing
facts and for whatever legal purpose it may serve.

AFFIANT SAYETH NONE.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ___ day of

_____________________ in _____________________.

DIOSDADO S. AGUSTIN
(Affiant)
Senior Citizen’s ID No. CH-1395
Issued by: Office of the Senior
Citizens Affairs, Angeles City
Issued on: August 15, 2012

SUBSCRIBED AND SWORN TO before me this _____day of ___________________, 2019 in

__________________, _______________, Philippines, affiant exhibiting to me ____competent proof of
identity as found below his/her name.

Doc. No. __________;

Page No. __________;
Book No. __________;
Series of 2019.