REPUBLIC OF THE PHILIPPINES)

____________________________) SS

AFFIDAVIT OF DENIAL for NBI CLEARANCE

I, ____, of legal age, Filipino, married and a resident of ___, after having been duly
sworn to in accordance with law, hereby depose and state:

1. That the NBI Satellite Office in Bayombong, Nueva Viscaya had advised me that
the said office cannot issue the required clearance in view of the appearance of
name similar to my name in NBI Files in in case/s filed against said person bearing
names similar to mine;

2. That I am NOT the same person as on __ a.k.a. ____ who was charged under
Criminal Case no. ___ before MTC Branch ___, Santiago City for the crime of
________;

3. That I categorically deny having committed nor be subjected to any court in relation
to the above-mentioned charge or offense;

4. That I am executing this affidavit to attest to the foregoing facts and to deny
categorically and specifically under oath that I am not the same person mentioned
in the docket/files of NBI with the said derogatory/civil/criminal record/s;

In view of the foregoing, I am requesting NBI Main Office in Taft Avenue, Manila through
the _____ Satellite Office in _____ to issue the appropriate NBI clearance in my favor.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ____ th day

of ____________ 20 ___ at ____________ , Philippines.

Affiant

SUBSCRIBED AND SWORN TO before me, a Notary Public for and in the City
_________________, Philippines this ___ day of ___ in __________________,
Philippines. Affiant personally came and appeared with ___card___ issued by the ____
on ____, bearing his photograph and signature, known to me as the same person who
personally signed the foregoing instrument before me and avowed under penalty of law
to the whole truth of the contents of said instrument.

Doc. No.____;
Page No. ____;
Book No. ____;
Series of 2020.