Republic of the Philippines)

Province of Eastern Samar) S.S.

Balangiga, E. Samar
)
AFFIDAVIT OF PENDENCY OF ADMINISTRATIVE/ CRIMINAL CASE
I, ISABELO B. GURA, of legal age, Filipino, with permanent address at Barangay
Poblacion 02, Giporlos, E. Samar, after having been duly sworn to in accordance with law,
hereby voluntarily depose and say:
1.

I am formerly employed as Municipal Assessor of the Local Government

Unit of Giporlos, E. Samar;

2.

That I am applying for compulsory retirement to take effect/effective last

November 1, 2015;

3.

That there is a pending case against me in the Ombudsman, details of which

are as follows:
Nature/specific offenses charged: Administrative Case and Criminal
Case under RA. 3019 but does not involve pecuniary liability.

4.

That I am executing this affidavit to attest to the truth of the foregoing facts
for the expeditious processing of my retirement benefits.

IN WITNESS HEREOF, I have set my hand and affixed my signature this 15 th day of
November, 2015 at Balangiga, E. Samar.
ISABELO B. GURA
Affiant
SUBSCRIBED AND SWORN to before me this 15th day of November, 2015, affiant
exhibited to me his Government Issued I.D. Senior Citizen with No. 0865 issued at Giporlos, E.
Samar on 01/11/2011.

Doc. No. ________;

Page No. ________;
Book No. ________;
Series of 2015.