REPUBLIC OF THE PHILIPPINES)

) S.S.
_______City. . . . . . . . . . . . . . . . . .)

AFFIDAVIT

I, ______________________________________ of legal age, single/married,

residing at __________________________________________________________
after having been sworn according to law, depose and say:

That I am not accused of any criminal offense involving moral turpitude before
any civil court in the Philippines, neither have I been previously convicted of any such
offense; nor am I facing charges involving misconduct before any military court or
administrative body including any provincial or city fiscal;

That I do not advocate am I a member of any unlawful or subversive organization

that advocate the overthrow of the government of the Philippines or any other
government;

That I clearly understand that any misrepresentation or falsehood used by me in

the furtherance of any application for commission/CAD/ADT shall be grounds for court
martial charges or any administrative proceedings deemed appropriate by the proper
authority.

FURTHER AFFIANT SAYETH NONE:

___________________________
Affiant

SUBSCRIBED AND SWORN to before me this _____ day of ____________

20___ at ________________________ affiant exhibited to me his Residence Certificate
Nr _______________issued at ______________________________ on ____________
20_____.

__________________________
Notary Public

Doc. No. _____

Page No._____
Book No _____
Series of _____