REPUBLIC OF THE PHILIPPINES)

CITY OF _________ . . . . . . . ) S.S

x----------------------------------x)

AFFIDAVIT OF NO PENDING
CIVIL OR CRIMINAL CASE
I, ______________________, of legal age, married/single/separated/widowed,
Filipino, and a resident of ____________________________________________________,
after having been duly sworn to an oath in accordance with law hereby depose and state:
That I am currently employed at the ______________;
That I have no pending case, criminal or civil, before any judicial authorities or
agency in the government;
That I am neither an advocate nor a mentor of any unlawful or subversive
organization that advocated the overthrow of the government or agency in the
government;
That I was never accused of any offense or crime involving moral turpitude, neither
one of the same nature or a pending case of anti-graft law (RA 3019) against my person is
pending before any prosecution office and judicial authorities elsewhere in the Philippines;
That I am executing this affidavit to attest to the truth of all the foregoing
declarations and for whatever legal purpose this may serve.
IN WITNESS WHEREOF, I have hereunto set any hand this ___ day of _________,
____, in the __________________, Philippines.

______________________________
Affiant

SUBSCRIBED AND SWORN to before me this ___________________ day of _________

in _____________________. Affiant exhibited to me his/her Com. Tax Cert No. _________
issued on _________________ at ____________, _____________________.

Doc No.
Page No.
Book No.
Series No.

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