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REPUBLIC OF THE PHILIPPINES
Sandiganbayan Quezon City
================================================================================
1. Judicial Records Division Ground Floor
2. Statistics -do-
3. Atty. Renato T. Bocar -do-
4. Cashier -do-
5. Atty. Renato T. Bocar -do-
Steps in Securing Clearance
Requirements
1. Accomplished form with picture 1x1
2. Processing Fee - P100.00 (If by Mail attached
Postal Money Order pay to SANDIGANBAYAN. Please
enclosed self addressed stamped envelope.)
3. Affidavit of Denial (if with namesake) ================================================================================
Date : ATTY. RENATO T. BOCAR Executive Clerk of Court IV O f f i c e Sir: May I respectfully request for Clearance/Certificate in connection with my
(Purpose of clearance)
[PLEASE WRITE LEGIBLY]
________________________________ Signature over Printed Name APPLICANT’S PERSONAL DATA:
1. Name:
(Complete Middle Name)
2. Residential Address:
4. Civil Status: 5. Date of Birth: 6. Place of Birth:
7. Tel. Number: 8. Cellphone No.: 9. E-mail address:
10. Sex : ( ) Male ( ) Female
(First Name) (Last Name)
3. Office/Office Address:
[This portion is for the Docket Section]
Sandiganbayan Commonwealth Avenue, Quezon City
Date:
A certain
of
was charged before the Sandiganbayan in Criminal/Civil/Case/s No./s
filed on for
said case/s
(Name of Accused)
(Office)
(Status of Case/s)
(Designation of Offense)
Note: As of this date and per records on file LEONORA R. CONTACTONo Civil/Criminal cases has been filed SB Supervising Judicial Staff Officer
against Judicial Records Division
Note: Validity good for six (6) months only. [ P L E A S E W R I T E L E G I B L Y ]
__________________________________________________________________________________________________ /eac Commonwealth Avenue, Quezon City, Website: sb.judicial.gov.ph; Tel. No. 951-4497