REPUBLIC OF THE PHILIPPINES }

QUEZON CITY } S.S.

AFFIDAVIT OF DENIAL OF IDENTITY

I, (name) , (age) years old, Filipino, with address at (address), after having been
sworn to in accordance with law, depose and state:

1. That when I was about to (circumstance/s for acquiring the affidavit), I

was advised that I have a namesake with a pending criminal case, to wit:

Case No. Crime/Offense/Infraction Branch/Status

2. That upon verification, there really appears a criminal case filed against
one (person bearing the similar name);

3. That I am not the same (similar name) that is indicated for in the above
criminal case and I therefore declare that I am not the same person with the namesake
(similar name) in the said criminal case for the same is merely coincidental;

4. That I am executing this affidavit to attest to the truthfulness of the

foregoing statements and for whatever legal purpose this may serve best;

IN WITNESS WHEREOF, I have hereunto affixed my signature this ___ day of

_______ 20___ at ______.

(name)
Affiant

SUBSCRIBED AND SWORN to before me this ____ day of ______ 20___ in

_______, affiant exhibiting to me his (type of ID) No. (ID number) issued in _______.

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2018