REPUBLIC OF THE PHILIPPINES )

PROVINCE OF BATANGAS ) S. S.
CITY OF TANAUAN )

AFFIDAVIT OF DENIAL

I, _______________, a Filipino, of legal age, and a resident of

_____________Batangas, after having been duly sworn to in accordance with law, do
hereby depose and state THAT:

1. I was born on ______________ in Mandaluyong, Metro Manila;

2. I established my permanent residence in ______________, Batangas;

3. On _____________, I applied for a Record Clearance from the National

Bureau of Investigation (NBI) – Lipa City, Batangas Branch;

4. I received an information from the NBI that my namesake, a certain

_______________, has a pending criminal case for Piracy/Mutiny docketed as Criminal
Case No. _____________ pending before Branch 019 of the Regional Trial Court of
Naga City, Camarines Sur;

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

6. 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. I am executing this affidavit to attest to the truthfulness and veracity of the

foregoing statements and to deny absolutely and entirely any involvement in the case
aforementioned and for whatever legal intents and purposes it may serve

Affiant further sayeth naught.

IN WITNESS WHEREOF, I have hereunto set my hand this 1st day of July 2016
at Tanauan City, Batangas, Philippines.

_________________
Affiant

SUBSCRIBED AND SWORN to before me this 1st day of July 2016 at Tanauan
City, Batangas, Philippines, affiant exhibiting to me his Professional Driver’s License with
No. N02-_________________ bearing his picture and signature.