REPUBLIC OF THE PHILIPPINES)

CITY OF MAKATI ) S.S.

x-------------------------------------x

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 have hereunto set my hand this ____ day of ___________ 20____ in ____________, _____________, Philippines.

___________________________________

Affiant

SUBSCRIBED AND SWORN to before me, this ____ day of __________ 20____, in the City of __________________, by ___________________ with Passport No.________________ issued on __________________ at _____________.

Notary Public

Doc. No. ______;

Page No. ______;

Book No. ______;

Series of ______;