You are on page 1of 2

FM-POEA-06-ESRD-03-b-SRA

Effective May 16, 2012

REPUBLIC OF THE PHILIPPINES )


MANDALUYONG, METRO MANILA ) S.S.

AFFIDAVIT OF UNDERTAKING
I, ______________________________________, of legal age, single/married, Filipino,
a resident of ____________________________________ and with business address at
_________________________________________ after having been subscribed to an oath,
depose and say:

1. That I am the incumbent


______________________________________________________
( position of affiant)
of ___________________________________________, a domestic corporation organized
under
( name of agency)
Philippine Laws, and a duly licensed recruitment agency as per License No.
_____________________________ issued by the Philippine Overseas Employment
Administration;

2. That as licensed recruitment agency, we requested the POEA to issue in our


favor an authority to conduct recruitment activities in the following provinces/cities
on the corresponding dates:
_______________________________________________ _________________________
_______________________________________________ _________________________
_______________________________________________ _________________________

3. That in my capacity as _________________________ of the


________________________
( position of affiant) (name of
__________________________, I hereby DECLARE and ASSUME full responsibility in the
orderly
agency)
conduct of recruitment activities of __________________________________________ who
has
(name of representative)
been authorized to represent our agency in the recruitment activities in the above-
mentioned place/s and date/s;

4. That I likewise DECLARE and ASSUME full and complete responsibilities for all
consequences which may arise in connection with the conduct of above recruitment
activities;

5. That I execute this Affidavit of Undertaking in compliance with the


requirements in the issuance of an authority to conduct special/provincial recruitment
activity.

In witness hereof, I hereby set my hand this _____th day of _________________, 20__,
in _______________________________.

______________________________________
(Affiant)

SUBSCRIBED AND SWORN to before me this __th day of


__________________________. Affiant exhibited to me his/her Residence Cert. No. as
indicated above below his name.

NOTARY PUBLIC
Doc. No. ____________
Page No.____________
Book No. ____________
Series of 2012