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_____________.
Sample only
I, GANDI T. LUGASAN of legal age, married, (citizenship) and residing at (place address here) hereby depose and state:
1. That I attend the National Public Sector Labor Management Congress last (date) at the (venue and address);
2. That due to the huge number of participants coming from different parts of the country, we, together with the other Management Sector participants, were not accommodated in the conference room as certified by Director Ragenil of CSC;
3. That I paid the amount of One Thousand Five Hundred Pesos ($1,500.00) as Congress fee for the participants but the Congress Kit and Meal Stub runs out and I was not given any stub and kit;
4. That the Official Receipt #020210 was surrendered to be able to get the Meal Stub and Congress Kit and never been returned to me;
5. That I am executing this affidavit to attest to the truthfulness of the above-mentioned statement, and for liquidation purposes.
AFFIANT FURTHER SAYETH NAUGHT.
_________________________
GANDI T. LUGASAN
Affiant
A F F I D A V I T
I, ROGER T. RICAFORT of legal age, married, (citizenship) and residing at _______________after having been sworn to in accordance with law, hereby, depose and say:
1. That I am the duly elected Position of the Municipality of ___________of ______________:
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-requirement of the Department of Interior and Local Government and for the other legal purposes.
Affiant Further Sayeth Naught.
GANDI F. LUGASAN
Affiant
SUBSCRIBED AND SWORN to before me this ____ day of _______ at______, ______, affiant entrusted to me his Community Tax Certificate no. ____________ issued on ________________ at _________________.
AFFIDAVIT OF DISCREPANCY
I, (Name, Citizenship, of legal age, Civil status), and with residence and postal address at ______________________________ after having been duly sworn to in accordance with law, do hereby depose and state:
1. That I am the child out of wedlock of (Name of father) and (Name of Mother who are native of ___________________________;
3. That since my parents were not legally married and the fact that they have already been separated since my infant age, I used the last name of my mother (Lastname) used in my school records and other transactions I entered. Copies of my School Transcript of Records and Diploma and other pertinent documents are hereto attached as Annex hereof;
4. That I discovered, however, in my Certificate of Live Birth, my full name is (the name used) instead of (the name supposed to be used). Machine copies of the said Certificate of Live Birth is hereto attached as Annex hereof;
5. In order to avoid confusion, I now categorically state under oath that the names (complete name) as appearing in my school records and complete name) as appearing in my certificate of live birth pertain to one and the same person;
6. I am executing this affidavit to attest to the truth of the foregoing statements and for all legal intents and purposes it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of _____ 2005 in _______________
(Current Name Used)
Affiant
SUBSCRIBED AND SWORN to before me this ____ day of ______ 2005 in _____________by Affiant, exhibiting to me her CTC number ________________ issued on _____________at ________ _____________.
Doc. No. ___________:
Page No. ___________:
Series of: __________:
Notary Public
