Republic of 

the Philippines)
City of _______________ ) S.S

AFFIDAVIT

I, , of legal age, married with postal and residence address at, after being duly sworn to in
accordance with law, hereby depose and state that:

1. I am

2. There is no complaint(s) filed against the undersigned pending with the Civil Service
Commission, Office of the Ombudsman, any Prosecutor’s Office, Department of Justice,
or any regular courts or the Court of Appeals and the Supreme Court; or pending
administrative case with the Philippine National Police or any Administrative body; and

3. I am executing this sworn statement to lend to the veracity of the foregoing statement and
for whatever legal purpose or purposes that it may serve to support my application for
Best Senior Police Commissioned Officer for Administration and for Best Senior Police
Commissioned Officer for Operations;

AFFIANTS FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ of ____________

at_____________, Philippines.

__________________________
Affiant

SUBSCRIBED AND SWORN to before me this____ of _________ by affiant exhibited

to me his/her ____________ issued at _____________ City on ________________.

Doc. No. ______;
Page No. ______;
Book No.______;
Series of  ______.