Republic 

of the Philippines )
Province of Palawan )S.S.
City of Puerto Princesa )

AFFIDAVIT OF DENIAL

I, ___________________, of legal age, Filipino, (single/married/widow) and a resident of

_______________________________, after having been duly sworn to in accordance with law,
depose and state:

1. That I was born on ________________ in __________________________;

2. That I established my permanent residence in __________________, Philippines;

3. That on ___________________, I applied for a Record Clearance from the National Bureau

of Investigation;

4. That I received an information from the National Bureau of Investigation on ______________

that my namesake, a certain _______________________, has a pending criminal case for
Attempted Homicide docketed as Criminal Case No. 1234 pending before Branch 67 of the
Metropolitan Trial Court of Quezon City;

5. That I hereby unequivocally deny involvement in the aforementioned case;

6. That I also declare under oath that I am not in any way involved in any case proceeding as
either plaintiff/complainant or defendant/accused in the Philippines and abroad, specifically with
regard to the aforementioned case;

7. That I have been employed or residing in Hong Kong for ________ years to this date;

8.That ___________________________________________________ (cite other proof/s or

reason/s to substantiate your claim that you are not involved in the aforementioned case/s, if
any); and

9. That I am executing this Affidavit to attest to the foregoing facts and to deny absolutely and
entirely any involvement in the case/s aforementioned and for all legal intents and purposes.

IN WITNESS WHEREOF, I hereby affixed my signature this ___________________ in

Makati City, Metro Manila, Philippines.

____________________
Affiant

SUBCRIBED AND SWORN TO before me this _____________ in

______________, Philippines, affiant exhibiting to me his/her competent evidence of identity by
way of ______________ issued at _____________ on ______________.
   
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2022.