DPRM RSD FORM 2015-01-C
Republic of the Philippines
National Police Commission
NATIONAL HEADQUARTERS, PHILIPPINE NATIONAL POLICE
Camp Crame, Quezon City
I, ________________________________________________
____, of legal age, Filipino, presently residing at
(First Name) (Middle Name)
(Last Name/Qualifier)
_________________________________________________af ter having duly sworn to in accordance with 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 decl ared birth date indicated therein shall be uncontes table six months after submission to RMD, DPRM;
3.
Any doubtful application of changes, adjustment for
any purpose whatsoever shall be automatic ground f or denial;
4.
I have not been dishonorably discharged from milita ry employment or on Absence Without Official Leave or Dropped from PNP Rolls or dismissed for cause from any civi lian position in the Government;
5.
I have no previous appointment in the PNP as well a s proof of record of resignation in any uniformed g overnment service. The discovery thereof, in any stage of val idation, attestation and confirmation of appointmen t as Police
Inspector shall not prejudice the PNP to cancel, re voke, recall and/or subsequently nullify anytime th e appointment order and corresponding attestation;

6.
I have no pending criminal and/or administrative ca se in any court, administrative and quasi-judicial bodies including
Office of the Ombudsman;
7.
I have not been convicted by final judgment of an o ffense or crime involving falsification of document s, perjury and moral turpitude;
8.
Any fraudulent entry therein shall be a ground for the filing of a criminal and administratively case for perjury, falsehood, misrepresentation 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 i n 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 a re true and accurate to the best of my knowledge an d ability and I hereby authorized the PNP to obtain and secure pert inent records that will show my qualification stand ards, collateral requirements and case records and other record rela ted to this declaration if any, in any agency or of fice.
That I attest to the truthfulness of the fo regoing declaration and submit myself to the legal consequences thereof, if ever the statements above are wanting in truth and in substa nce.
_____________________________________
Affiant
SUBSCRIBED AND SWORN TO
before me this ____ day of _______________, 20___,
at ____________________________,
Philippines.
_______________________________

(Notary Public)