7/25/2019 clearanceform sandiganbayan.pdf

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Republic of the Philippines

SandiganbayanQuezon City

Requirements: Steps in Securing Clearance

1. Accomplished Form with 1x1 picture

2. Affidavit of Denial (If with namesake). rocess ng ee - . e y ma p ease

Date :

ATTY. RENATO T. BOCARExecutive Clerk of Court IV

O f f i c e

Sir :

May I respectfully request for Clearance/Certificate in connection with my

APPLICANT'S PERSONAL DATA :

Civil Status :

Date of Birth :

Place of Birth

Residential Address : Sex :

Tel. No. :

CP No. :

E-mail Address :

Date :

Validity : Good for six (6) months only.

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attached Postal Money Order pay to SANDIGANBAYA

enclosed with self addressed stamped envelope.

(PURPOSE OF CLEARANCE)

~ please write legibly ~

Signature over Printed Name

First Name :

Complete Middle Name:

Last Name :

A certain _____________________________________________________________________

~ please write legibly ~

o _____________________________________________________________________________

(This Portion is for the Docket Section)

ndig nb y n

Office & Office Address :

(Name of Accused)

Note: As of this date and per records on file NO CRIMINAL/CIVIL/CASE/s has been

filed against

(1 x 1 picture)

said case/s _____________________________________________________________________(Status of Case/s)

(Complete Name)

LEONORA R. CONTACTO

Chief, Judicial Staff Officer

Judicial Records Division

(O f f i c e )

was charged before Sandiganbayan in Criminal/Civil/Case/s/No./s __________________________

filed on __________________ for ____________________________________________________(Designation of Offense)

Commonwealth Avenue, Quezon City

DocketSection

StatisticsSection

Atty. RenatoT. Bocar

CashierAtty. Renato

T. Bocar

Commonwealth Avenue, Quezon City; Website: sb.judiciary.gov.ph; Tel. No. 951-44-97