Republic of the Philippines )

Province of Cagayan ) S.S.

Tuguegarao City )
x------------------------------------------x

AFFIDAVIT
I, BIBIANA N. CAGURANGAN, Filipino, of legal age and a resident of
Linao West, Tuguegarao City, Cagayan, under oath, hereby depose
and state:

1. That I am a retired employee of the Office of the Vice Governor-

Provincial Government of Cagayan holding the position of
Administrative Aide I;

2. That I am in the process of requesting for the release of my

Terminal Leave Benefits;

3. That as part of the requirements thereof, I hereby state for all

intents and purposes that there is no pending criminal and/or
administrative investigation or prosecution filed against me;

4. That I am executing this Affidavit freely, voluntarily and intelligently

to attest to the truthfulness of the foregoing statements.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 2nd day

of April 2019 in Tuguegarao City, Cagayan, Philippines.

BIBIANA N. CAGURANGAN
Affiant

SUBSCRIBED AND SWORN to before me on the date and place above

written. The affiant is personally known to the Notary Public.

Notary Public

Doc. No.
Page No.
Book No.
Series of 2019