Republic of the Philippines )

Quezon City, Metro Manila ) S.S

AFFIDAVIT OF DENIAL

I, WILLIAM DELA CRUZ, of legal age, single, Filipino citizen, with residence
and postal address at Blk. 4 Kaingin 1 Brgy. Pansol, Quezon City, after having
been duly sworn to in accordance with law do hereby depose and say:

1. That I am applying for a clearance with the National Bureau of

Investigation/Regional Trial Court/Metropolitan Trial Court/Philippine
National Police/Office of the City Prosecutor B of Immigration;

2. That however, appearing under the name of PO3 WILLIAM DELA CRUZ (no
middle name) is/are the following case/s, to wit:

Criminal Case No. 137085-86

Nature of Case: Alarms & Scandal Attempted Homicide
Filed with Metropolitan Trial Court of Quezon City Branch 33
Status: Acquitted 6-24-14

3. That the said PO3 WILLIAM DELA CRUZ with the above mentioned pending
case/s is a different person and not the undersigned;

4. That the undersigned has never been charged with any criminal, civil or
administrative case in any court or tribunal of the Republic of the
Philippines; and

5. That I execute this affidavit to attest to the truth and veracity of the above
foregoing facts and for all other legal and purposes it may serve.

FURTHER AFFIANT SAYETH NAUGHT:

WILLIAM DELA CRUZ

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this ____ day of September 2018 in

Quezon City. Affiant exhibiting to me his UMID ID NO. CRN-0111-1056835-0 as
proof of his identity.

Doc No.
Page No.
Book No.
Series of 2018