Affidavit
Republic of the Philippines )______________________ ) S.
S.AFFIDAVITI,
_____________________________________________________________ of
legal age, __________________________ presently residing at
_____________________________________________________________________
having been duly sworn to in accordance with law, depose and
say:
1.That I was formerly employed as
_______________________________________________________ in the
____________________________________________________________;
2.That I am retiring under RA1616/PD 1146, RA660 effective
____________________________________________________________;
3.That there is no administrative criminal investigation against
me for any offense, defined or penalized under RA3019, otherwise
known as the Anti- Graft and Corrupt Practices Act, as amended and
under the provisions of the Revised Penal Code; and
4.That I am executing this affidavit to attest to the truth of
the foregoing facts or assertation in compliance with COA
Memorandum No. 451 dated March 6, 1973.
IN WITNESS HEREOF, I have set my hand and affixed my signature
this ________ day of _____________________, ___________________ at
________________________________.
_________________________
Affiant
SUBSCRIBED AND SWORN TO BEFORE ME this ________ day of
____________________, ___________ in _____________________________,
affiant exhibiting to me his/her Residence Certificate No.
______________________.Doc. No. __________
Page No. __________
Book No. __________
Series of __________
__________________________
Notary Public
