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REPUBLIC OF THE PHILIPPINES )

___________________________ ) S.S.

AFFIDAVIT OF NO RELATION

I, ________________, of legal age, Filipino citizen, with principal address at


________________, after having been duly sworn to in accordance with the law, hereby
depose and say that:

1. On _______________, I have ________________ as Member of the Governing Board of


_______________________;
2. I am aware that after the enactment of Republic Act No. 10149, all appointments to the
Governing Boards of GOCCs covered by the law shall be appointed by the President of
the Philippines from a list submitted by the Governance Commission for GOCCs (GCG);
3. I am also aware of the Constitutional prohibition for any appointee to be a relative by
consanguinity and/or affinity within the fourth (4th) civil degree to the President of the
Philippines;
4. I, therefore, declare that I am neither a relative by consanguinity nor affinity within the
fourth (4th) civil degree of President Benigno S. Aquino III, and am qualified to be
appointed as Member of the Governing Board of the abovementioned GOCC for which I
______________________;
5. I am executing this Affidavit to attest the truth of the foregoing and for whatever legal
purpose/s this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this _______ day of


______________, __________________ at ________________ City.

__________________________
Affiant

SUBSCRIBED AND SWORN to before me this ____ day of ______________ ________,


Affiant exhibited to me his ___________________________, a government-issued ID with
number ___________________, bearing his photo and signature, expiring on
____________________.

Doc. No. _________;


Page No. _________;
Book No. _________;
Series of _____.

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