AFFIDAVIT OF DENIAL

I, ____________________________________________, of legal age,

single/married/widow, citizen of ______________________ and presently residing at
_________________________________________, after having been duly sworn to in
accordance with law, do hereby depose and say:

That I am applying for landed immigrant in _____________________ and in the

process, I am required to submit an overseas police clearance from the Philippine
National Bureau of Investigation (NBI) in Manila;

That in compliance with the requirements of the _________________ Immigration,

I submitted my application for NBI in the Philippines;

That NBI Office in Manila 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;

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 Office to issue the appropriate

police clearance in my favor for compliance with the certain requirements.

IN WITNESS WHEREOF, I have hereunto set my hand this ___________ at

__________________________, Philippines.

__________________________
(Affiant)