REPUBLIC OF THE PHILIPPINES )

PROVINCE OF BATANGAS ) S. S.
CITY OF TANAUAN )

AFFIDAVIT OF DENIAL

I, _________________, ___ years of age, married, Filipino, and a resident

________________, after having been sworn to in accordance with law, hereby depose
and say THAT:

1. I was born on ______________ in __________________;

2. I established my permanent residence at _________________________;

3. On _______________, I applied for a Record Clearance from the National

Bureau of Investigation (NBI) Lipa City, Batangas Branch;

4. I received an information from the NBI that my namesake, a certain

_________________, has a pending criminal case for Piracy/Mutiny docketed as
Criminal Case No. 83-2247 pending before Branch 019 of the Regional Trial
Court of Naga City, Camirines Sur;

5. I hereby unequivocally deny involvement in the aforementioned case;

6. 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, specially with regard to the aforementioned case;

7. I am executing this affidavit to attest to the truthfulness and veracity of the

foregoing statements and to deny absolutely and entirely any involvement in the
case aforementioned and for whatever legal intents and purposes it may serve.

Affiant further sayeth naught.

IN WITNESS WHEREOF, I have hereunto set my hand this April 7, 2017 at

Tanauan City, Batangas, Philippines.

Affiant

SUBSCRIBED AND SWORN to before me this April 7, 2017 at Tanauan City,

Batangas, Philippines, affiant exhibiting to me his ________________, bearing his
picture and signature to prove his identity.