Republic of the Philippines

Province of Negros Occidental ) S.S

_____________________________

x--------------------------------------------------x

AFFIDAVIT OF NON-PENDENCY OF
ADMINISTRATIVE/CRIMINAL CASE

I, JUAN DE LA CRUZ, of legal age, Filipino, single/married and a resident of Brgy.

II- Poblacion, E.B. Magalona, Negros Occidental, after having been duly sworn in
accordance with the law, hereby voluntarily depose and say:

1. That I was employed as Sanggunian Bayan Member (ABC President) in the

Municipality of E.B. Magalona and my term ended on July 16, 2018;
2. That I have applied for Terminal Leave effective June 4, 2020;
3. That there is no pending administrative, criminal investigation against me for any
offense, defined or penalized under RA 3019, otherwise known as the Anti-Graft and
Corrupt Practices Act as amended, and under the provisions of the Revised Penal
Code;
4. That I am executing this Affidavit to attest to the truth of all the above-stated facts.

IN WITNESS WHEREOF, I have hereunto affixed mysignature this ____ day of

_____________________, 2020 at E.B. Magalona, Negros Occidental, Philippines.

JUAN DE LA CRUZ
Affiant

SUBSCRIBE AND SWORN TO BEFORE ME this ____ day of ______________

2020, affiant exhibited to me his Government issued ID ________________________ with
no. ___________________ issued at ______________________ on
_____________________________.

Doc. No: _______

Page No.: _______
Book No.: _______
Series of _______
5. That there is no
pending administrative
criminal investigation
against
6. me for any offense,
defined or penalized
under RA 3019, otherwise
known as
7. the Anti-Graft and
Corrupt Practices Act, as
amended and under the
provisions
8. of the Revised Penal
Code;
9. That there is no
pending administrative
criminal investigation
against
10. me for any offense,
defined or penalized
under RA 3019, otherwise
known as
11. the Anti-Graft and
Corrupt Practices Act, as
amended and under the
provisions
of the Revised Penal
12.