REPUBLIC OF THE PHILIPPINES)

CITY OF MANILA ) 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 was accused of being affiliated to an

unrecognized organization within San Beda College Mendiola.

4. That I received an information from the Dean's Office of the College of Law on
______________ that I am being reprimanded for violating the following
provisions of the Student Manual to wit: (INSERT ALLEGED VIOLATED RULES);

5. That I hereby unequivocally deny violating the provisions of the Student

Manual and the Waiver I executed during my enrollment;

6. That I also declare under oath that I am not in any way involved in any
altercation physical or otherwise between the alleged parties/organizations;

7.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 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 2016.