Republic of the Philippines)

)
) S.S.

AFFIDAVIT OF CONFIRMATION

I, __________________________________, a Filipino of legal age, a resident of

________________________________________, a bonafide member of the Philippine National Police with the
rank of __________________ and presently assigned at _________________________________________ after
having been duly sworn to in accordance with law, do hereby depose and says that:

1. Pursuant to this affidavit, I am confirming that the following are my legal beneficiaries and/or
heirs, to wit:

NAME RELATIONSHIP BIRTH DATE

2. My relationship with persons whose names are listed above are borne out by the fact that I am
the lawful spouse and the legitimate/illegitimate father/mother of the aforementioned named children
as evidenced by the attached marriage contract and birth certificates.

3. I hold myself criminally and administratively liable for perjury and dishonesty should any
statements made herein are inaccurate of later found to be false and in of law.

AFFIANT SAYETH NAUGHT.

(Signature of PNP Personnel)

Affiant

SUBSCRIBED AND SWORN to before me this ______ day of _________________, at

_____________________________, Philippines.

Doc. No. _______

Page No. _______
Book No. _______
Series of _______
 DPRM RSD FORM 2015-01-C

Republic of the Philippines

National Police Commission
NATIONAL HEADQUARTERS, PHILIPPINE NATIONAL POLICE
Camp Crame, Quezon City

AFFIDAVIT OF INCONTESTABILITY

I, _________________________________________________________, of legal age, Filipino,

(First Name) (Middle Name) (Last Name/Qualifier)
presently residing at_____________________________________________________ after having duly sworn to in
accordance with the law, do hereby depose and state that:

1 I am a graduate of ________________________________________________________ and

(Degree/Course)
holder of __________________________________________ eligibility;

2 I was born on________________________ and that my declared birth date indicated therein shall be
uncontestable six months after submission to RMD DPRM;

3 Any doubtful application of changes, adjustment for any purpose whatsoever shall be automatic
ground for denial;

4 I have not been dishonourably discharged from military employment or on Absence Without
Official Leave or Dropped from PNP Rolls or dismissed for cause from any civilian position in the
Government;

5 I have no previous appointment in the PNP as well as proof of record of resignation in any
uniformed government service. The discovery thereof, in any stage of validation, attestation and
confirmation of appointment as Police Inspector shall not prejudice the PNP to cancel, revoke,
recall and/or subsequently nullify anytime the appointment order and corresponding attestation;

6 I have no pending criminal and/or administrative case in any court, administrative and quasi-
judicial bodies including Office of the Ombudsman;

7 I have not been convicted by final judgement of an offense or crime involving falsification of
documents, perjury, and moral turpitude;

8 Any fraudulent entry therein shall be a ground for filing of a criminal and administratively case
for perjury. Falsehood, misinterpretation or omission or act of dishonesty or for any fraudulent,
falsification, or tampered documents that I have submitted.

9 I have read and checked all the entries appearing in my Personal Data Sheet (PDS) and that I
certify that all entries thereof are true and correct;

10 I further certify that the foregoing declarations are true and accurate to the best of my
knowledge and ability and I hereby authorized the PNP to obtain and secure pertinent records
that will show my qualification standards, collateral requirements and case records and other
record related to this declaration if any, in agency or office.

That I attest to the truthfulness of the foregoing declaration and submit myself to the legal
consequences thereof, if ever the statements above are wanting in truth and in substance.

_______________________________________
Affiant

SUBSCRIBED AND SWORN TO before me this _____ day of __________,

20_________, at
_____________________, Philippines.

_______________________________________
Notary Public
RDS DPRM FORM 2017-1A

Republic of the Philippines

National Police Commission
NATIONAL HEAD QUARTERS, PHILIPPINE NATIONAL POLICE
Camp Crame, Quezon City
AFFIDAVIT OF UNDERTAKING
(POLICE OFFICER 1 PSF QOUTA APPLICANT)

I, ___________________________________________________________of legal age.

(First Name) (Middle Name) (last Name/Qualifier)
Filipino and presently residing at
______________________________________________________after having duly sworn to in
accordance with law do hereby depose and state:

1. That I am a Police Officer 1 (PO1) applicant for this CY__________Regular

Recruitment Program of ________________._________;
(Unit/Officer)
2. That I was born on _______________________.
3. That I am a graduate of __________________________________________and holder
of
(Degree/Course)
_________________________________eligibility.
4. That I have not been dishonourably discharge from military employment or
on Absences Without Official Leave or Dropped from Rolls from the PNP service or
dismissed for cause from any civilian position from the Government;
5. That I have no pending criminal case in any court, including at the office of
the ombudsman or administrative case;
6. That I have not been convicted by the final judgment of an offense or crime
involving moral turpitude;
7. That I agree to the automatic nullification of my appointment as Police
Officer 1 and hold myself liable for perjury, falsehood, misrepresentation or
omission of facts, if there exists a pending case against me and/or falsification or
act of dishonesty for any fraudulent, fake or tampered documents that I have
submitted;
8. That I will not resign from the service within three (3) years after having
taken my oath of office nor seek reassignment/ detail with other PNP units or
allied services outside of __________ for at least five (5) years;
(Unit)

9. That I further certify that the foregoing declarations are true and accurate to
the best of my knowledge and ability and I hereby authorized the PNP to obtain and
secure pertinent records that will show my qualification standards, collateral
requirements and case records and other record related to these declaration if any ,
in any agency or office.

FURTHER AFFIANT SAYETH NONE

_____________________________________
(Affiants Signature over
Printed name)

SUBSCRIBED AND SWORN to before me this ___ day of ______, 20__ at

________________ ____________, Philippines, affiant exhibiting his/her CTC NO.
_______ issued at ________________________________________ on
_______________________.
 NOTARY
PUBLIC
Police Regional Office 5
st
1 Cycle 2017 PO1 Regular Recruitment Program

INITIAL DOCUMENTARY REQUIREMENTS

TABLE OF CONTENTS
PERSONAL DATA SHEET A
(CSC form 212 Revised 2017-Handwritten/computerized)

REPORT RATING OF ELIGIBILITY B

(Authenticated by the issuing party)

NSO BIRTH CERTIFICATE (original) C

TRANSCRIPT OF SCHOLASTIC RECORDS WITH D

CERTIFICATE OF GWA-TOR, AND DIPLOMA
(Authenticated by the School Registrar)

LOCAL CLEARANCES E
(Barangay, police, NBI, and RTC/MTC)

Two pcs 2x2 Colored ID Picture with white F

background

One pc 4r Whole Body Picture G

1 pc Bust Size Picture H

CERTIFICATE OF GOOD MORAL CHARACTER FROM I

UNIVERSITY (Authenticated by the issuing party)

2 Valid IDs (Photocopy) J

Affidavit of Undertaking K

Photocopy of TIN ID or BIR form, and Online L

Application
 TABLE OF CONTENTS
PERSONAL DATA SHEET A
(CSC form 212 Revised 2017-Handwritten/computerized)

REPORT RATING OF ELIGIBILITY B

(Authenticated by the issuing party)

NSO BIRTH CERTIFICATE (original) C

TRANSCRIPT OF SCHOLASTIC RECORDS WITH D

CERTIFICATE OF GWA-TOR, AND DIPLOMA
(Authenticated by the School Registrar)

LOCAL CLEARANCES E
(Barangay, police, NBI, and RTC/MTC)

Two pcs 2x2 Colored ID Picture with white F

background

One pc 4r Whole Body Picture G

1 pc Bust Size Picture H

CERTIFICATE OF GOOD MORAL CHARACTER FROM I

UNIVERSITY (Authenticated by the issuing party)

2 Valid IDs (Photocopy) J

Affidavit of Undertaking K

Photocopy of TIN ID or BIR form, and Online L

Application
 BASBAS MARGIE ALABAT
CABUSAO, CAMARINES SUR