Republic of the Philippines )

Tarlac City ) S.S.

AFFIDAVIT OF DENIAL

I, _____________________ of legal age, married, Filipino citizen, and a resident

of Barangay Quezon, Gerona, Tarlac, Philippines, after having been duly sworn to in
accordance with law, do hereby depose and state THAT:

1. I went before the National Bureau of Investigation (NBI) ________ to apply

for an NBI Clearance but the same was not released since I was informed
that I have a pending case before the RTC __________________

2. Upon verification, I learned that a certain _________ was charged for

Qualified Theft docketed as Case No. ________;

3. This ____________has no middle name and is from a different place;

4. I attest that I am not the same as the ___________ involved in the above-
mentioned cases and have no knowledge as to the identity of the said person;

5. It so happened that there is another person unknown to me who has the

same name like mine;

6. I have not committed any crime before. I was never arrested nor charged for
any crime, more so with the specified cases nor have been arrested for the
crimes above stated.

7. I am executing this Affidavit to DENY that I am the person accused in the said
criminal cases;

8. Finally, I am executing this Affidavit to attest to the truth of the foregoing

statements and for all legal intents and purposes this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 6 th day of

July 2021 in Tarlac City, Philippines.

_________________________
Affiant

SUBSCRIBED AND SWORN to before me on the date and place indicated

above. Affiant presented before me his SSS ID with serial number ______________
issued by SSS Philippines.