ANNEX E

<DATE>

SELF-CERTIFICATION OF NO ADMINISTRATIVE
AND/OR CRIMINAL CASES

This is to certify that to the best of my knowledge, I have no

administrative and/or criminal cases pending before any court of law or quasi-
judicial body.

(Name and Signature)

(Position)

SUBSCRIBED AND SWORN to before me, this by the above

affiant who exhibited to me his/her Employee's Identification No.
issued by the Bureau of Internal Revenue, Quezon City.

Doc. No.
Page No.
Book No.
Series of ______