REPUBLIC OF THE PHILIPPINES)

________ CITY
) SS.
AFFIDAVIT
I, (Insert Name of Affiant) , Filipino citizen, of legal age, single/married to
(Insert Name of Spouse if any), and a resident of (Insert Address of Affiant), after having
been duly sworn in accordance with law, hereby depose and say:
1. .......................................................................................................................
...........................................................................................................................
...........................................................................................................................
2. ........................................................................................................................
............................................................................................................................
............................................................................................................................
2. ........................................................................................................................
............................................................................................................................
............................................................................................................................
Further Affiant sayeth none.
IN WITNESS WHEREOF, I have hereunto affixed my signature this ......... day
of ..................... , 20__ in ..................................... Philippines.
........................................................................
(Signature of Affiant over Printed Name)

SUBSCRIBED AND SWORN before me this........ day of ........................... 20__,

by ............................................. who exhibited to me his CTC No. ...................................
issued on ................................. at ...........................................
Notary Public
Doc. No. .........:
Page No. .........;
Book No. .........;
Series of 20__.

REPUBLIC OF THE PHILIPPINES)

CITY OF MAKATI
x----------------------------x

) S.S.

AFFIDAVIT OF LOSS

I, ___________________, of legal age, Filipino, (single/married/widow) and a resident of

_______________________________, after having been duly sworn to in accordance with law,
depose

and

state THAT:

1. I am a duly-licensed driver in accordance with pertinent Land Transportation laws, rules and
regulations, and was issued a corresponding (Non) Professional Driver's License with number
_____________ which is valid until _____________;
2. Sometime on ____________, said driver's license was misplaced and got lost;
3. Efforts were exerted to locate said driver's license, but in spite of diligent search, it could not
be found and the same is now beyond recovery;
4. Said Driver's License has not been confiscated by the LTO, Police or other Traffic Enforcers for
any traffic violation;
5. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing and
to support my application for the issuance of a new (Non) Professional Driver's License, in
lieu of the one that was lost;
IN WITNESS WHEREOF, I have hereunto set my hand this ___________________ in
Makati City, Metro Manila, Philippines.

____________________
Affiant
SSS ID No. _____________

SUBCRIBED

AND

SWORN

TO before

me

this ___________________ in

_________________, Philippines, affiant exhibiting to me his/her competent evidence of identity

by way of __________________ issued at ______________ on __________________.
Doc. No. _____;
Page No. _____;

Book No. _____;

Series of 2013.

REPUBLIC OF THE PHILIPPINES)

CITY OF MAKATI

) S.S.

x-------------------------------------x

AFFIDAVIT OF LOSS

I, GERARDO L. TAN, of legal age, Filipino, single and a resident of 2222 Washington
Street, Pio del Pilar, Makati City, after having been duly sworn to in accordance with law,
depose and state:
1. That I am a holder of Automated Teller Machine (ATM) Card No. 123456789 duly issued in my
favor by Banco de Oro Unibank, Inc. on January 12, 2010 in Makati City;
2. That I used to put said ATM card in my wallet;
3. That sometime on July 20, 2013, when I arrived home from work, I discovered that saidATM
card was no longer in my wallet;
4. That diligent effort to locate the same proved futile;
5. That in view thereof, I now desire and hereby request BDO to issue another ATM card in lieu
of the lost one;
6. That I bind myself to save BDO harmless from any loss or damage that it may incur in
connection with the issuance of a new ATM card in lieu of the lost one;
7. That I am executing this affidavit to attest to the foregoing facts and for any legal purpose it
may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 29th day of July 2013 in
Makati City, Metro Manila, Philippines.

GERARDO L. TAN
Affiant
Voter's ID No. 5555

SUBCRIBED AND SWORN TO before me this 29th day of July 2013 in Makati City, Metro
Manila, Philippines, affiant exhibiting to me his valid proof of identification.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2013.

Republic of the Philippines

Department of Justice
National Prosecution Service
OFFICE OF THE CITY PROSECUTOR
Makati City

AFFIDAVIT OF DESISTANCE

WE, FERDINAND M. CASTRO and ROWENA A. CASTRO, Filipinos, of legal ages,

husband and wife, respectively, and residents of 106 Sisa Street, Sampaloc, Manila after
having been duly sworn to in accordance with law, depose and state:
1. We are the private complainant in a criminal case for Reckless Imprudence Resulting to
Damage to Property against Joel O. Castillo docketed as IS No. XV-05-INV-10G-01000 before
the Office of the City Prosecutor, Makati City
2. In this regard, the accused has already paid the damage to our vehicle;
3. In view of the payment by the accused and considering that Rowena A. Castro was not
injured, we would like to manifest that we now completely and absolutely exonerate the
accused from any liability in connection with the above-mentioned criminal case and that we
are no longer interested, and we hereby desist, in prosecuting the said criminal case;
4. As such, we respectfully pray that the aforementioned case against Joel O. Castillo be
withdrawn and/or dismissed.

IN WITNESS WHEREOF, we have hereunto set our hands this ___________________ in

_______________, Philippines.

FERDINAND M. CASTRO

ROWENA A. CASTRO

Affiant

Affiant

Philippine Passport No. _____

Philippine Passport No. _____

Issued at: ________________

Issued at: ________________

Issued on: ________________

Issued on: _______________

SUBCRIBED

AND

SWORN

TO before

me

this ___________________ in

_________________, Philippines, affiants exhibiting to me their valid proofs of identification.

Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2013.

RELEASE WAIVER AND QUITCLAIM

KNOW ALL MEN BY THESE PRESENTS:
That I, __________________, Filipino, of legal age, a resident of __________________, and
formerly employed with __________________, do by these presents acknowledge receipt of the
sum of __________________, Philippine Currency, from _____________________ in full payment
and final settlement of the (financial assistance or separation pay, overtime pay, salary or
salaries, wage or wages, commutable sick and vacation leaves, gratutities or any kind of
compensation

or

emoluments)

due

to

me

or

which

may

be

due

to

me

from

____________________ under the law or under any existing agreement with respect thereto, as
well as any and all claims of whatever kind and nature which I have or may have against
________________, arising from my employment with (and the termination of my employment
with ______________________.
In consideration of said payment, I do hereby quitclaim, release, discharge and waive
any and all actions of whatever nature, expected, real or apparent, which I may have against

_______________, its directors, officers, employees, agents and clients by reason of or arising
from my employment with the company. I will institute no action, whether civil, criminal,
labor or administrative against _________________, its directors, officers, employees, agents
and clients. Any and all actions which I may have commenced either solely in my name or
jointly

with

others

before

any

office,

board,

bureau,

court,

or

tribunal

against

_________________, its directors, officers, employees, agents and clients are hereby deemed
and considered voluntary withdrawn by me and I will no longer testify or continue to
prosecute said action(s).
I declare that I have read this document and have fully understood its contents. I
further declare that I voluntarily and willingly executed this Release, Waiver and Quitclaim
with full knowledge of my rights under the law.
IN WITNESS WHEREOF, I have hereunto set my hand at _____________, this ___ day of
_______________,

2000.

_______________________
Affiant

SIGNED IN THE PRESENCE OF

_______________________

______________________

REPUBLIC OF THE PHILIPPINES)

CITY OF MAKATI

) S.S.

x-------------------------------------x

AFFIDAVIT OF DENIAL

I, ___________________, of legal age, Filipino, (single/married/widow) and a resident of

_______________________________, after having been duly sworn to in accordance with law,
depose and state:

1. That I was born on ________________ in __________________________;

2. That I established my permanent residence in __________________, Philippines;
3. That on ___________________, I applied for a Record Clearance from the National Bureau of
Investigation;
4. That I received an information from the National Bureau of Investigation on ______________
that my namesake, a certain _______________________, has a pending criminal case for
Attempted Homicide docketed as Criminal Case No. 1234 pending before Branch 67 of
the Metropolitan Trial Court of Quezon City;
5. That I hereby unequivocally deny involvement in the aforementioned case;
6. That I also declare under oath that I am not in any way involved in any case proceeding as
either plaintiff/complainant or defendant/accused in the Philippines and abroad, specifically
with regard to the aforementioned case;
7. That I have been employed or residing in Hong Kong for ________ years to this date;
8.That ___________________________________________________ (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. That 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.
IN WITNESS WHEREOF, I hereby affixed my signature this ___________________ in
Makati City, Metro Manila, Philippines.

____________________
Affiant

SUBCRIBED

AND

SWORN

TO before

me

this _____________ in

______________, Philippines, affiant exhibiting to me his/her competent evidence of identity by

way of ______________ issued at _____________ on ______________.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2013.
REPUBLIC OF THE PHILIPPINES)
CITY OF MAKATI

) S.S.

x-------------------------------------x
AFFIDAVIT OF WITNESS

I, ___________________, of legal age, Filipino, (single/married/widow) and a resident of

_______________________________, after having been duly sworn to in accordance with law,
depose and state:
1. That I was present and personally saw that accused, __________, committed the crime of
_______________________ against the victim __________________;
2. That ___________________________ (State other circumstances and the relation either to the
victim or accused or both);
3. That ___________________________ (State the details of the acts committed by the accused
against the victim);
4. That ___________________________ (State the acts done by the witness and the reason
thereof);
5. That I executed this affidavit to attest the truthfulness of the foregoing facts and to
support the

filing of criminal

case against

____________________

for

violation

of

________________________.

IN WITNESS WHEREOF, I hereby affixed my signature this ___________________ in

Makati City, Metro Manila, Philippines.

____________________
Affiant
SUBCRIBED

AND

SWORN

TO before

me

this ___________________ in

_________________, Philippines, affiant exhibiting to me his/her competent evidence of identity

by way of _________________ issued at ______________ on __________________.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2013.