I, XXX, of legal age, Filipino, with permanent address at Palo, Leyte, after having

been duly sworn to in accordance with law, hereby voluntarily depose and say:

1. I am an employee with a position of Administrative Office I of the Municipality

of Palo, Province of Leyte;

2. That I am applying for authority to travel abroad on April 8 to April 30, 2017;

That there is no pending administrative criminal investigation against me for any offense,
defined or penalized