(Affidavit of Denial of Criminal Cases)

Republic of the Philippines)

Province of _________________)S.S.
City/Municipality of ____________)
x---------x

AFFIDAVIT OF DENIAL

I,_____________, Filipino, of legal age,(single / married / widow), and as resident

of____________, Philippines, having been duly sworn in accordance with law, hereby depose
and state:

That I am NOT the same person as one____________a.k.a.__________who was charged under

I.S. No._____________/ Criminal Case No._____________before the___________for the crime
of___________;

That I have never been the subject of any criminal complaint, charge or proceeding before any
prosecutor or court;

As such, I am executing this Affidavit to certify or attest to the truth of the foregoing facts and
for purpose of denying that I am the _____________ who is the subject of the aforementioned
case and for whatever legal purpose that this Affidavit may serve.

IN WITNESS WHEREOF, we have set our hands this__________, in the City of____________,
Philippines.

(JURAT)