REPUBLIC OF THE PHILIPPINES)

PROVINCE OF TARLAC : S.S.

MUNICIPALITY OF BAMBAN )

AFFIDAVIT OF DENIAL

I, _____________________________, of legal age, Filipino, married, with

residence and postal address at
__________________________________________________________ , after having been
duly sworn to in accordance with law, do hereby depose and say;

THAT—

1. I have never been accused of any crime in any court in the Philippines, nor do I
have any pending case in court;

2. However, when I applied for loan with the Security Bank Personal Loan
Department, I found out that a certain _____________________________, whose
whereabouts is unknown and have pending case filed against him;

3. From the records, it appears that I, _____________________________, presently

residing at __________________________________________________________ and
_____________________________, are two distinct and different persons;

4. I am executing this Affidavit of Denial to attest to the truth of all the foregoing
facts and for the purpose of denying herein that I am not the same person
mentioned by the Security Bank.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

____________________ at Bamban, Tarlac 2317, Philippines.

_____________________________
Affiant
ID No. _____________________

SUBSCRIBED AND SWORN to before me this ____________________ at

Bamban, Tarlac, Philippines, affiant exhibited to me his positive identification duly
noted above below his name and signature, known to me and to me known to be the
same person who executed foregoing Affidavit and acknowledged before me that the
same is her free act and deed and that he voluntary executed the same and understood
all the contents thereof.

WITNESS MY HAND AND SEAL.

Doc. No. _____;

Page No. ____;
Book No. ____;
Series of 2019.