AFFIDAVIT OF DENIAL
I, ______, of legal age, single, Filipino, with residence and postal ad-
dress at _______, having been duly sworn in accordance with law, states that:
1. That I need a clearance from the National Bureau of Investigation (NBI)
as a requirement for requesting my Certificate of Live Birth from the
_____;
2. The National Bureau of Investigation (NBI) of ______ has advised me that
the said office cannot issue the required clearance in view of the appear-
ance of a name similar to my name in the NBI Files in case/s filed against
said person bearing names similar to mine;
3. I am NOT the same person as ________ who was charged under Criminal
Case No. _____ before the _______ for ________;
4. I categorically deny having committed or having been subjected to any
court in relation to the above-mentioned charges or offenses;
5. I hereby certify that the statements made herein are true and correct to
the best of my knowledge;
6. In view of the foregoing, I am requesting the National Bureau of Investi-
gation (NBI) to issue the appropriate NBI Clearance in my favor.
IN WITNESS, I have hereunto set my hand this _______ in _____, Philip-
pines.
_________________________________________________
Affiant
SUBSCRIBED AND SWORN to before me in ______, this __ day of Sep-
tember 202_ by Affiant who presented her competent evidence of identity
and who signed the document in my presence and avowed under the penalty
of law to the whole truth of the contents of the foregoing Affidavit.
Doc. No. ______;
Page No. ______;
Book No. ______;
Series of 202_
