REPUBLIC OF THE PHILIPPINES)

___________________________) S.S.
x-------------------------------x

AFFIDAVIT OF NON PENDENCY OF CASE

I, GERONIDES R. GABINI , of legal age, Filipino and a resident of Purok 5, Magnaga,

Pantukan, Davao de Oro after having been duly sworn to in accordance with law, do hereby depose
and say THAT:

I was previously employed as Utility Worker III at Compostela Valley Provincial Hospital of
Municipality of Pantukan (CVPH-Pantukan) Davao de Oro;

I have no pending administrative, civil nor criminal case, before any judicial authority or
agency in the government;

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

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

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of

_____________________, in the ____________________________________, Philippines.

GERONIDES R. GABINI
Affiant

SUBSCRIBED AND SWORN to before me this ________ day of _____________________

in _____________________, Philippines.

Doc No. ____;

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