CLASS C

Republic of the Philippines )

City of ) S.S.

AFFIDAVIT OF NO DELINQUENT
FINANCIAL OBLIGATION

I, __________________, Filipino, of legal age, single/married, and a resident of

_____________________, after having been sworn in accordance with law hereby depose
and state that:

1. I am a candidate for hiring/promotion for the position of __________________

(PG___) at ______________________ of the Land Bank of the Philippines (Land Bank);

2. I am fully aware that the aforesaid position is imbued with public interest such
that any person appointed thereto is bound to observe the ethical standards prescribed by
law for public officials and employees which include, among others, the obligation to
conduct his /her personal financial affairs in a prudent manner in order to avoid financial
situations that could reflect unfavorably on the character of the appointee to the position
and to Land Bank as a premier government financial institution;

3. To the best of my knowledge and belief, I am not a respondent, defendant,

and/or an accused in any administrative, civil and/or criminal case filed and/or pending
before any court of law, administrative body or tribunal involving non-payment of financial
obligation;

4. That I have no past due or delinquent financial obligations (i.e unsettled accounts
with LBP Credit Card, financial institutions supervised by the BSP, LANDBANKERS’ Multi
Purpose Cooperative (LANDBANKOOP);

5. I am executing this affidavit to attest to the truth of the foregoing statements

and for the purpose of complying with the requirements of Land Bank Executive Order No.
130, Series of 2016, also known as the “Revised Guidelines in Handling Past Due Financial
Obligations of Land Bank Employees.”

IN TRUTH WHEREOF, I have hereunto affixed my signature this ____ day of

_________________20_____at _______________, Philippines.

_________________
Affiant

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

_______________Philippines, Affiant exhibited to me his/her __________issued on
______________at ___________ as competent proof of his/her identity.

_____________________
Notary Public

Doc. No. ___

Page No. ___
Book No. ___
Series of 20____