REPUBLIC OF THE PHILIPPINES

CITY OF _______________________)S.S

AFFIDAVIT OF NO PENDING
CIVIL OR CRIMINAL CASE

I, _______________________________________, of legal age, married/single/separated/widowed,

Filipino and a resident of ___________________________________________________________________________________,
after having been duly sworn to an oath in accordance with law hereby depose and state:

That I am currently employed at the _____________________;

The I will be my (type of travel) to (country of destination) on (travel date from and to).

That I am neither an advocate nor a mentor of any unlawful or subversive organization that
advocated the overthrow of the government or agency in the government;

That I was never accused of any offence or crime involving moral turpitude, neither one of
the same nature or a pending case of anti-graft law (RA 3019) against my person is pending before
any persecution office and judicial authorities elsewhere in the Philippines;

That I am executing this affidavit to attest to the truth of all foregoing declaration and for
whatever legal purpose this may serve.

IN WITNESS WHERE OF, I have hereunto set my hand this _____ day of _______________, ________,
in the ______________________________, Philippines

_____________________________________
Affiant

SUBCRIBED AND SWORN to before me this ________________________________ day of _______________

in _____________________. Affiant exhibited to me his/her Com. Tax Cert No. ____________________ issued on
_______ at _____________, ________________________________.

Doc No. _____________

Page No. ____________
Book No. ____________
Series No. ___________