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Republic of the Philippines) Province of _________________)S.S.

City/Municipality of ____________) x---------x AFFIDAVIT OF DENIAL I,_____________, Filipino, of legal age,(single / married / widow), and as resident of____________, Philippines, having been duly sworn in accordance with law, hereby depose and state: That I am NOT the same person as one____________a.k.a.__________who was charged under I.S. No._____________/ Criminal Case No._____________before the___________for the crime of___________; That I have never been the subject of any criminal complaint, charge or proceeding before any prosecutor or court; As such, I am executing this Affidavit to certify or attest to the truth of the foregoing facts and for purpose of denying that I am the _____________ who is the subject of the aforementioned case and for whatever legal purpose that this Affidavit may serve. IN WITNESS WHEREOF, we have set our hands this__________, in the City of____________, Philippines.