REPUBLIC OF THE PHILIPPINES)

____________________ ) S.S.

AFFIDAVIT OF NON-EMPLOYMENT
AND NO PENDING CASE

I, ________________, Filipino, of legal age, married, and a resident of

_______________________, after having been duly sworn in accordance with
law, hereby depose and say:

1. To this date, I am not regularly and gainfully employed in any capacity at

any corporation, company, individual person or with the government;

2. That I have No pending Administrative, Civil or criminal case record

from National Bureau of Investigation (NBI) and Philippine National
Police (PNP);

3. I am executing this Affidavit of Non-Employment and No pending case to

attest to the truth of the foregoing to support my application for Change
of First Name for R.A 9048 in my Certificate of Live Birth before the
Office of the Local Civil Registry of Caloocan City and for whatever legal
intent and purposes this may serve;

IN WITNESS WHEREOF, we have hereunto set our hands this

_______________ at the _______________.

__________________________
affiant

SUBSCRIBED AND SWORN to before me, this ________________

affiants exhibited to me his above stated competent proof of identity.

Notary Public

Doc No. ______;

Page No. ______;
Book No. II
Series of 2021.