Scribd
Upload
16 views1 page

Makati City Prosecutor Clearance Form

This document is a form from the Office of the City Prosecutor in Makati, Philippines, used for individuals applying for a clearance. It requires personal information, civil status, and inquiries about any past criminal charges. The applicant must certify the truthfulness of the information provided.

Uploaded by

silentobservers24
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
16 views1 page

Makati City Prosecutor Clearance Form

This document is a form from the Office of the City Prosecutor in Makati, Philippines, used for individuals applying for a clearance. It requires personal information, civil status, and inquiries about any past criminal charges. The applicant must certify the truthfulness of the information provided.

Uploaded by

silentobservers24
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Republic of the Philippines

Office of the City Prosecutor


Makati

__________________
Date

NAME: ___________________________________________________________________________
(Family Name) (Given Name) (Middle Name)

NICK NAME/ ALIAS: ______________________________ MAIDEN NAME: _______________

BIRTHDAY: ___________________ AGE: __________ TELEPHONE NO.: _________________

CIVIL STATUS: _________________ (IF MARRIED) NAME OF SPOUSE: ________________

ADDRESS: (RESIDENCE AND COMPANY) : _________________________________________

PURPOSE IN SECURING CLEARANCE: _____________________________________________

1. Have you ever been charged of any criminal case/offense in the City Prosecution Office
at Makati or any Court in the Philippines as indicated below?

YES or NO? __________WHERE? _______________________________________

2. Pending, dismissed, convicted or Acquired? ________________________________

(If YES, please attach the necessary documents: Court Order and/or Decision and/or Resolution of
Prosecutor)

THE ANSWER TO THESE QUESTIONS ARE MATERIAL REPRESENTATION TO


PROSECUTE IN CONNECTION WITH THE APPLICATION TO CRIMINAL PROSECUTION.

I HEREBY CERTIFY that the foregoing circumstances are true and correct.

_____________________________
Affiant

Left Thumb Mark Right Thumb Mark

Community Tax No.: ________________________


Date of Issuance: ___________________________
Place of Issuance: ___________________________

You might also like