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    Affidavit of Pendency/Non-Pendency of Administrative/Criminal Case


    Republic of the Philippines )
    _____________________ ) SS.
    x- - - - - - - - - - - - - - - - - - - - - x


    AFFIDAVIT OF PENDENCY/NON-PENDENCY 
    OF ADMINISTRATIVE/CRIMINAL CASE


    I, _______________________________, of legal age, Filipino, with permanent address at _________________________________________________, after having been duly sworn to in accordance with law, hereby voluntarily depose and say:

    1. That I am currently/formerly employed as ________________________________ in the Commission on Audit.

    2. That I am applying for optional/compulsory retirement to take effect/effective on _______________________;

    3. Pls. check [√] appropriate box

      That there is no pending administrative or criminal case filed against me in any forum

      That there is a pending case against me, details of which are as follows:

       Administrative                   Criminal

    Nature/specific offenses charged: _______________________________

    4. That I am executing this affidavit to attest to the truth of the foregoing facts for the expeditious processing of my retirement benefits.

    IN WITNESS WHEREOF, I have set my hand and affixed my signature this _________ day of ______________, 20 ______  at _______________________.



    _______________________________
    Affiant


    SUBSCRIBED AND SWORN TO BEFORE ME this _______ day of ___________, 20 ______, affiant exhibited to me his Government Issued ID __________ No. ______________ issued at __________________ on ___________________.


    Doc. No. _____
    Page No. _____
    Book No. _____
    Series of _____.



    NOTARY PUBLIC


    Source: coa.gov.ph

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