Republic of the Philippines )

Iloilo City ) s.s.

AFFIDAVIT OF NON-PENDENCY OF
ADMINISTRATIVE/ CRIMINAL CASE

I, Ma. Gerrylin S. Camposagrado, of legal age, Filipino, with permanent

address at Brgy. Baguingin, Tigbauan, Iloilo, after having been duly sworn to in
accordance with law, hereby voluntarily depose and say:

1. I am Member of the Sangguniang Bayan of the Municipality of Tigbauan in

the Province of Iloilo;

2. That I am applying for authority to travel abroad on September 10 to 16, 2019

to Guam, U.S.A;

3. That there is no pending administrative criminal investigation against me

for any offense, defined or penalized under RA 3019, otherwise known as the
Anti-Graft and Corrupt Practices Act, as amended and under the provisions of
the Revised Penal Code;

4. That I am executing this affidavit to attest to the truth of the foregoing facts for
the expeditious processing of my retirement benefits.

IN WITNESS HEREOF, I have set my hand and affixed my signature this __

___________________________ at ________________________

MA. GERRYLIN S. CAMPOSAGRADO

(Affiant)

SUBSCRIBED AND SWORN TO BEFORE ME this ____________________ at

________________________ Philippines, affiant exhibited to me her LTO Driver’s
Licence ID No. F03-97-105309.