Republic of the Philippines

____________________
___________________
__________________

CERTIFICATION

(Date)

To Whom It May Concern:

This is to certify that according to the available records of this

Court (name), (age), (civil status), residing at (address) and with (ID
with number) has NO CRIMINAL and CIVIL case pending before this
Court as of (time) in the morning of (date).

This certification is being issued upon the request of the

interested party for all legal intent and purposes.

(NAME)
(Designation)

Verified by:
(NAME)
Name (NAME)
(Designation)

(Right Hand Thumb Mark)

Paid under O.R. Nos. ______________ and _______________
Issued at (place of issucance)
(Date)

*Not valid without dry seal