Post on 28-Feb-2018
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