REPUBLIC OF THE PHILIPPINES )

_______________________________ ) S.S.

AFFIDAVIT OF NO PENDING CRIMINAL

AND ADMINISTRATIVE CASE

I, _________________, of legal age, Filipino citizen, _____, resident

of ________________________________, after being duly sworn in accordance
with law, hereby depose and state;

That I have no pending criminal, administrative civil and other related

cases before any courts or administrative body;

That I execute this Affidavit to affirm the truth of the foregoing facts.

IN WITNESS WHEREOF, I have hereunto affix my signature this ___

day of _______, 20___ at ____________________.

___________________
Affiant

SUBSCRIBED AND SWORN to before me this _____ day of _____,

200__, affiant exhibiting to me her/his Residence Certificate No. ____________
issued on ________________ at ____________.

Doc No._______
Page No.______
Book No.______
Series of 200__