Republic of the Philippines )

City of ) s.s.

AFFIDAVIT OF NON-PENDENCY OF
ADMINISTRATIVE/ CRIMINAL CASE

I, ________________, of legal age, Filipino, with permanent address at

___________, after having been duly sworn to in accordance with law,
hereby voluntarily depose and say:

1. That I am employed at the ___________;

2. 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;

3. That I am executing this affidavit to attest to the truth of the

foregoing facts that I have no derogatory record whatsoever; to
serve as supporting document for my application for _______

IN WITNESS HEREOF, I have set my hand and affixed my signature

this 7 day of_____________, Philippines.
th

(Affiant)

SUBSCRIBED AND SWORN TO BEFORE ME _________________

at ________________Philippines, affiant exhibited to me his Driver’s Licence
with No. ___________ issued at ___________ on __________.

Doc. No.: ___;

Page No.: ___;
Book No.: ___;
Series of 2022.