Republic of the Philippines)

City of Davao . . . . . . . . . .)S.S.

X.................../
AFFIDAVIT OF UNDERTAKING
I, __________________________________________, Filipino, ___ years
of age, and a resident of_____________________________________
_____________________________________________________, after having
been duly sworn to in accordance with law, hereby depose and say, THAT:
1. I am fully aware that the use of illegal drugs has no beneficial effect
whatsoever to the well being of any person;
2. I am also fully aware that any involvement in illegal drugs undermines
the efforts of the government to eradicate the drug menace that is
destroying the nation;
3. I now therefore voluntarily surrender and submit myself to the
government authorities for proper documentation or undergo appropriate
intervention or drug rehabilitation program/s, as the case may be;
4. I will no longer be involved in the illegal drugs or put to a stop any
involvement therein;
5. I sincerely thank the government for giving me the opportunity to have a
new and peaceful life and help in its campaign against illegal drugs;
6. I am executing this affidavit on my own free will and volition and fully
understands all the contents of the same having been translated in the
vernacular or dialect which I speak and is conversant with.
IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of
___________________________ 20___, at Davao City, Philippines.
Assisted by:
___________________________
Public Attorney
Roll of Attorneys No. _________

____________________________
Affiant
____________________________
(I.D. Presented)

Witnesses:
__________________________ and ______________________
SUBSCRIBED AND SWORN to before me this ___ day of
______________ _____, at Davao City, Philippines. I HEREBY CERTIFY that I
have personally examined the affiant and that I am fully satisfied that he/she
voluntarily executed and understood the same.

___________________________
Public Prosecutor