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20140922-FORMS-Declaration of Pendency or Non Pendency of Case

This document is a declaration of pendency or non-pendency of legal cases for an individual applying for retirement from government service. It states that the individual [1] is applying for optional or compulsory retirement effective on a given date. It also indicates whether [2] the individual has any pending administrative or criminal cases, including details of the specific offense if applicable. If there is a pending case, it provides information on [3] the venue of investigation/trial and whether the case is [5] on appeal. The individual attests to the truth of the statements and authorizes the head of agency to verify the status of any cases against them.

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Mara Hershiely Pajayon
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326 views

20140922-FORMS-Declaration of Pendency or Non Pendency of Case

This document is a declaration of pendency or non-pendency of legal cases for an individual applying for retirement from government service. It states that the individual [1] is applying for optional or compulsory retirement effective on a given date. It also indicates whether [2] the individual has any pending administrative or criminal cases, including details of the specific offense if applicable. If there is a pending case, it provides information on [3] the venue of investigation/trial and whether the case is [5] on appeal. The individual attests to the truth of the statements and authorizes the head of agency to verify the status of any cases against them.

Uploaded by

Mara Hershiely Pajayon
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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DECLARATION OF PENDENCY/NON-PENDENCY OF CASE

I, _____________________________________________, Filipino of legal age, with


permanent address at _______________________________________________________,
and holder of the position _________________________________________ at the
___________________________________________________, after being sworn in
accordance with law, hereby depose and state that:

1. I am applying for my OPTIONAL / COMPULSORY retirement from the


government service effective ____________________________:

2. I have:
2.1 no pending case1
2.2 a pending case

 administrative disciplinary case


 criminal case

3. The NATURE/SPECIFIC OFFENSE CHARGED in the pending


criminal/administrative disciplinary case is : _____________________________
_________________________________________________________________

4. The venue of the investigation/trial: ____________________________________

5. On appeal: YES NO

6. The appeal is pending before: _________________________________________

7. I am executing this Declaration of Pendency/Non-Pendency of Case to attest to


the truth of the foregoing facts and to enable me to process and secure the release
of my retirement benefits.

8. By executing this Declaration of Pendency / Non-Pendency of Case, I hereby


authorize the Head of Agency to verify the status of any case(s) filed against
me in any forum.

9. Further, I am executing this Declaration of Pendency / Non-Pendency of Case


under pain of criminal and/or administrative liability under existing laws.

________________________________
Signature over printed name

SUBSCRIBED AND SWORN to before me this ___ day of __________________,


affiant exhibiting to me his / her ________________________________.

____________________________
(Person Administering Oath)
1
A pending case shall refer to both criminal and administrative disciplinary case. An administrative disciplinary case is considered when
the disciplining authority has issued a formal charge or a notice of charge to the respondent, while a criminal case shall be considered
pending from the time an Information or Complaint is filed in court.

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