REPUBLIC OF THE PHILIPPINES)

Province ofPangasinan) S.S.

City of Dagupan)
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AFFIDAVIT OF DENIAL for NBI CLEARANCE

I, CARLITO PEDRINO Filipino, of legal age, married to LANI PEDRINO, and a resident of Block
7, Brgy. Matulungin, Dagupan City, Pangasinan after having been duly sworn in accordance with
law, hereby depose and state:

1. That the NBI Main Office in Fernandez Ave., Dagupan has advised me that said Office
could not issue the required clearance in view of the appearance of name similar to my
name in NBI files involving in case/s filed against said person bearing names similar to
mine;

2. That I am NOT the same person as one CARLITO PEDRINO a.k.a. PEDRING who
was charged under I.S. No.45678 / Criminal Case No.12345678 before the Municipal
Circuit Trial Court for the crime of theft;

3. That my middle name is SANTOS and not PELANGKES.

4. That I am executing this affidavit to attest to the foregoing facts and to deny
categorically and specifically under oath that I am not the same person mentioned in the
docket/files of NBI with the said derogatory/civil/criminal record/s;

In view of the foregoing, I am requesting NBI Main Office in Taft Avenue, Manila to issue the
appropriate NBI clearance in my favor.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 2th day of June 2021 at
Dagupan City, Philippines.

CARLITO PEDRINO
(Signature of Affiant over Printed Name)

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in and for Pangasinan
this 2th day of June 2021. Affiant personally came and appeared with Philippine national
identity card issued by the Philippine Statistics Authority on October 3, 2020 at SM
Dagupan bearing his photograph and signature, known to me as the same person who
personally signed the foregoing instrument before me and avowed under penalty of law
to the whole truth of the contents of said instrument.

Atty RICARDO PEREZ

Notary Public
Doc. No. 123 Commission Serial No.12456784
Page No. 16 Notary Public for Pangasinan
Book No. 9 Until December 31, 2022
Series of 2021 Office: Perez Notary Public
Roll No. 198765
IBP Lifetime Roll No. 234567; 08/06/21 ; Pangasinan
PTR No. 567432 ; 08/05/21 ; Pangasinan
MCLE Compliance Cert. No. 345678; 08/06/21