AFFIDAVIT OF DENIAL

I, , of legal age, Filipino,

and presently residing at
, Hong Kong SAR / Macao SAR, and after having been duly sworn to in
accordance with law, do hereby depose and say:

1. I was born on in ;
2. I established my permanent residence in
, Philippines;
3. On , I applied for a Record Clearance from the
National Bureau of Investigation through the Philippine Consulate General in
Hong Kong SAR;
4. I received an information from the National Bureau of Investigation on
that my namesake, a certain
, has pending criminal case/s for
(cite case nos. and designation of the case) pending before :
5. I hereby unequivocally deny involvement in the aforementioned cases;
6. I also declare under oath that I am not in any way involved in ay case proceeding
as either plaintiff/complainant or defendant/accused in the Philippines and
abroad, specifically with regard to the aforementioned case/s;
7. I have been employed or residing in Hong Kong / Macao for years to
this date;
8.
(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. 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.

AFFIANT SAYETH NAUGHT.

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

of 20 in Hong Kong SAR / Macao SAR.

Affiant

SUBSCRIBED AND SWORN to before me this day of

20 in Hong Kong SAR, affiant exhibiting to me his/her Philippine Passport/ Hong Kong/
Macao identity card no. issued on
in Hong Kong SAR / Macao SAR.

Doc. No. :
Page No. :
Book No. :
Series of :
Svc. No. :
O.R. No. :
Fee Paid : HK$