Republic of the Philippines )
Quezon City ) S.S.
AFFIDAVIT
I, _______________________, OF LEGAL AGE, A MEMBER OF THE
PHILIPPINE NATIONAL POLICE, PRESENTLY THE
__________________________ EFFECTIVE ___________________ WITH
RESIDENCE AND POSTAL ADDRESS _______________________________
AFTER HAVING BEEN DULY SWORN IN ACCORDANCE WITH LAW, DO
HEREBY DEPOSE AND STATE:
THAT, I AM AN APPLICANT FOR FOREIGN TRAVEL AUTHORITY TO
ATTEND THE _________________________________________________ TO BE
HELD IN __________________ FROM _________________________;
That, I have no pending criminal or administrative case or any other claim filed
against me in any court, tribunal or quasi-judicial agency to include and the Office of
the Ombudsman, Commission on Human Rights or the PLEB as of this date;
That, I am not a witness to any drug related case, otherwise, I shall secure a
permission from the court;
That, I will hold myself liable for perjury, falsehood, misrepresentation or
omission, if there exists a pending case against me and/or falsification or act of
dishonesty for any fraudulent, fake or tampered documents that I submitted;
That, I will fulfill the required service obligation as provided by the policies of
the government, based on the duration of scholarship, training and similar
undertaking; and
That, I attest to the truthfulness of this understanding and I submit to the legal
and administrative consequences thereof, if ever the statements above are wanting
in truth and in substance.
AFFIANT FURTHER SAYETH NONE:
_______________________________
(Affiant’s Signature over Printed Name)
SUBCRIBED AND SWORN to before me this _________ day of
___________, 20_____ at _____________________________, Philippines.
________________________
Administering Officer