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

Affidavit COA Forms


Republic of the Philippines )
_____________________ ) SS.
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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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