REPUBLIC OF THE PHILIPPINES

Sandiganbayan
Quezon City

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Steps in Securing Clearance 1. Judicial Records Division Ground Floor 2. Statistics -do3. Atty. Renato T. Bocar -do4. Cashier -do5. Atty. Renato T. Bocar -do-

Requirements 1. Accomplished form with picture 1x1 2. Processing Fee - P100.00 (If by Mail attached
Postal Money Order pay to SANDIGANBAYAN. Please enclosed self addressed stamped envelope.)

3. Affidavit of Denial (if with namesake)

Date :

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ATTY. RENATO T. BOCAR Executive Clerk of Court IV Office Sir: May I respectfully request for Clearance/Certificate in connection with my
(Purpose of clearance)

[PLEASE WRITE LEGIBLY]

________________________________
Signature over Printed Name APPLICANTS PERSONAL DATA:

1. Name:
(First Name) (Complete Middle Name) (Last Name)

2. Residential Address: 3. Office/Office Address:

4. Civil Status: 7. Tel. Number:

5. Date of Birth: 8. Cellphone No.:

6. Place of Birth: 9. E-mail address:

10. Sex : ( ) Male ( ) Female

[This portion is for the Docket Section]

Sandiganbayan
Commonwealth Avenue, Quezon City

Date: A certain
(Name of Accused)

of
(Office)

was charged before the Sandiganbayan in Criminal/Civil/Case/s No./s filed on said case/s
(Status of Case/s)

for
(Designation of Offense)

Note: As of this date and per records on file No Civil/Criminal cases has been filed against

NELIA CASANO GALLO

SB Chief Judicial Staff Officer Judicial Records Division

[P LEASE WRITE LEGIBLY] __________________________________________________________________________________________________ Commonwealth Avenue, Quezon City, Website: sb.judicial.gov.ph; Tel. No. 951-4497 /eac
Note: Validity good for six (6) months only.