Cover Letter

I, GANDI T. LUGASAN of legal age, married, and residing at (ADDRESS )after having been sworn to in accordance with law, hereby, depose and say:

1. That I am the duly elected (Position and seat of position);
2. That I have no pending criminal or administrative case filed or pending against me before any court, tribunal or body at this time;
3. That if I knew a case has been filed or pending against me, I shall submit a clearance or a certification from said court, tribunal or administrative body that an authorization for me to travel abroad;
4. That I am executing this affidavit to attest to the truthfulness to the above-mentioned statements and for my application for foreign travel per requirement of the DILG and for other legal purposes.

Affiant Further Sayeth Naught.

GANDI T. LUGASAN
Affiant

SUBSCRIBED AND SWORN to before me this (date) day of (Month and year) at (Town), (Province), affiant entrusted to me his Community Tax Certificate no._________ issued on ______________ at_____________.