CLAS Form No.

005

Republic of the Philippines)

______________________ ) S.S.

AFFIDAVIT OF FULL COMPLIANCE

I, NAME OF CLAS LAWYER, of legal age, (civil status), Filipino

citizen, and a resident of (complete residential mailing address), after
being duly sworn to in accordance with law, do hereby depose and
say that:

1. I was admitted to the Bar and signed the Roll of Attorneys

with No. ____________ on ___Date of Signing___;

2. In compliance with Administrative Matter No. 17-03-09-

SC otherwise known as the “Rule on Community Legal
Aid Service,” I have rendered pro bono legal aid services
to the indigent clients of NAME OF LEGAL AID SERVICE
PROVIDER (IBP Home/Host Chapter);

3. Attached herewith are: (a) the Notarized Certificate of

Compliance dated ___________ issued by IBP-_______
Chapter as Annex “A”; and (b) the Certification dated
_________ also issued by IBP-_______ Chapter as Annex
“B”;

4. I am executing this Affidavit for submission to the

Supreme Court’s Office of the Bar Confidant in
accordance with the Guidelines for Monitoring
Compliance of Covered Lawyers in the Community Legal
Aid Service pursuant to A.M. No. 17-03-09-SC, and for
whatever legal intents this may serve best.

IN WITNESS WHEREOF, I have hereunto set my hand, this

________________ at the _________________.

NAME OF CLAS LAWYER

Petitioner

SUBSCRIBED AND SWORN to before me at the

________________, this ________________, affiant-petitioner exhibited to
me his IBP I.D. with Roll No. ____________ which will expire on
________________.

Doc. No. ____

Page No. ____
Book No. ____
Series of _____.