Republic of the Philippines

Sandiganbayan
Quezon City

Requirements: Steps in Securing Clearance

1. Accomplished Form with 1x1 picture
2. Affidavit of Denial (If with namesake)
3. Processing Fee - P100.00 (If filed by mail please Docket Statistics Office of the Office of the
Cashier
Section Section ECC IV ECC IV
attached Postal Money Order pay to SANDIGANBAYAN
enclosed with self addressed stamped envelope.)
4. Letter of authorization if through representative.

Date : APRIL 26, 2022

ATTY. MA. TERESA S. PABULAYAN

Executive Clerk of Court IV
Office (1 x 1 picture)

Madam :

May I respectfully request for Clearance/Certificate in connection with my

application for Prosecutor I (Associate Prosecutor) with the DOJ through the Regional Prosecutor's Office
(PURPOSE OF CLEARANCE)
~ PLEASE WRITE LEGIBLY ~
PINA LUZ C. ABREA
Signature over Printed Name
APPLICANT'S PERSONAL DATA :

First Name: PINA LUZ Civil Status: MARRIED

Complete Middle Name: CATARMAN Date of Birth: JUNE 28, 1986
Last Name: ABREA Place of Birth: SOGOD, SO.LEYTE
Residential Address: PUROK BANAHAW, BRGY. NASAUG, Sex: FEMALE

MAASIN CITY, SOUTHERN LEYTE Tel. No.: 053-570-8097

Office & Office Address: CITY TOURISM OFFICE, LGU MAASIN Mobile No: 09173288025
CITY, MAASIN CITY, SO. LEYTE E-mail Address: chenabrea@gmail.com

(This Portion is for the Docket Section)

Sandiganbayan
Commonwealth Avenue, Quezon City
~ please write legibly ~
Date :
A certain _____________________________________________________________________
(Name of Accused)
of _____________________________________________________________________________
(O f f i c e )
was charged before Sandiganbayan in Criminal/Civil/Case/s/No./s ___________________________
filed on __________________ for ____________________________________________________
(Designation of Offense)
said case/s ______________________________________________________________________
(Status of Case/s)

Note : As of this date and per records on

file NO CRIMINAL/CIVIL/CASE/s has been GUILLERMO S. NACARIO, JR.
filed against Acting Chief Judicial Staff Officer
Judicial Records Division
(Complete Name)

No validity/expiration date: Only issued date as per Certification.

/eac

Commonwealth Avenue, Quezon City; Website: sb.judiciary.gov.ph; Tel.No.(02) 951-44-97