AFFIDAVIT OF DENIAL

I, ____________, of legal age, single/married and a resident of

____________________________________, on oath declares:

1. That I was born at ______________________on ___________ and

resided there to present. Attached herein is the photocopy of my Certificate
of Live Birth, and other government ID Cards.

2. That since _______ I never left _________________________.

3. That I am not the person accused in the following cases:

a. Criminal Case No. _________ for ____________ pending

with _________________;
b. Criminal Case No. _________ for ____________ pending
with _________________; and
c. Archived Criminal Case No. _________ for ____________
pending with _________________.

4. That I am executing this affidavit to attest to the truth to the

foregoing facts and to deny that I still have a criminal case pending before
any court.

IN WITNESS WHEREOF, I hereunto affix my signature this

___________ at _________________.

___________________________
Affiant

SUBSCRIBE AND SWORN to before me this ___________ at

____________, affiant is exhibiting to me his _____________ issued on
____________ at ____________.

Doc. No.:____;
Page No.:____;
Book No.:____;
Series of _____.