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
inaccordance 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 2013.