REPUBLIC OF THE PHILIPPINES)

CITY OF MAKATI                       ) S.S.
x-------------------------------------x
  

AFFIDAVIT OF DENIAL

I, ___________________, of legal age, Filipino, (single/married/widow)

and a resident of _______________________________, after having been duly
sworn to in accordance with law, depose and state:

1. That I was born on ________________ in __________________________;

2. That I established my permanent residence in __________________,

Philippines;

3. That on ___________________, I applied for a Record Clearance from

the National Bureau of Investigation;

4. That I received an information from the National Bureau of Investigation on

______________ that my namesake, a certain _______________________,
has a pending criminal case for Attempted Homicide docketed as Criminal Case
No. 1234 pending before Branch 67 of the Metropolitan Trial Court of
Quezon City;

5. That I hereby unequivocally deny involvement in the aforementioned case;

6. That I also declare under oath that I am not in any way involved in any case

proceeding as either plaintiff/complainant or defendant/accused in the
Philippines and abroad, specifically with regard to the aforementioned case;

7. That I have been employed or residing in Hong Kong for ________ years
to this date;

8.That ___________________________________________________
(cite other proof/s or reason/s to substantiate your claim that you are not
involved in the aforementioned case/s, if any); and

9. That I am executing this Affidavit to attest to the foregoing facts and

to deny absolutely and entirely any involvement in the case/s aforementioned
and for all legal intents and purposes.

IN WITNESS WHEREOF, I hereby affixed my signature

this ___________________ in Makati City, Metro Manila, Philippines.
 ____________________
Affiant

SUBCRIBED AND SWORN TO before me this _____________ in

______________, Philippines, affiant exhibiting to me his/her competent
evidence of identity by way of ______________ issued at _____________
on ______________.
   
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2013.