Affidavit of Denial Pro Forma

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REPUBLIC OF THE PHILIPPINES)

QUEZON CITY ) S.S.


x-------------------------------------x

AFFIDAVIT OF DENIAL

I, ________________, of legal age, Filipino, married and a resident of #38


Kapiligan St., Brgy. Doña Imelda, Quezon City, after having been duly sworn to in
accordance with law, depose and state:

1. That I was born on ________________ in __________________________;

2. That I established my permanent residence


in _________________________________;

3. That on February 22, 2018, I applied for a Business Permit from the Quezon
City Hall;

4. That I received an information from the Quezon City Hall on February 22,
2018 that my namesake, a certain _________________, has a balance for
_____________________. Due to this, my application was denied;

5. That I hereby unequivocally deny that I am one and the same with the
person having balances due to the Quezon City hall;

6. That I also declare under oath that I have not previously applied for any
business permit;

7. That this will be the first time that I will be applying for a business permit
before the City Hall of Quezon City;

8.That attached are copies of my birth certificate and valid Social Security
System (SSS) ID that will distinguish me from my namesake in the records of
the Quezon City Hall; and

9. That I am executing this Affidavit to attest to the foregoing facts and to


deny absolutely and entirely that I am one and the same with the person with
record of balances due to Quezon City Hall for all legal intents and purposes.

IN WITNESS WHEREOF, I hereby affixed my signature


this ___________________ in Quezon City, Metro Manila, Philippines.

____________________
Affiant

SUBCRIBED AND SWORN TO before me this _____________ in


______________, Philippines, affiant exhibiting to me his/her competent evidence
of identity by way of ______________ issued at _____________
on ______________.

Doc. No. _____;


Page No. _____;
Book No. _____;
Series of 2018.

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