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

COA affidavit of pendency/ non-pendency of administrative/criminal case

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______________
) S.S.

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. 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 case

Criminal case

Nature/specific offenses charged: _________________________________
(specify)
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 HEREOF, 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/her Government Issued ID
__________with No._________________
issued at ____________________ on
____________________.
Doc. No. ________
Page No. ________
Book No. ________
Series of ________

NOTARY PUBLIC
 
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