Republic of the Philippines )

Province of Southern Leyte ) s.s.

City of Maasin )

AFFIDAVIT OF UNDERTAKING

I, DAEL CHURCHILL T. GERONG, of legal age, married, and a resident of Brgy.

Mantahan, Maasin City, Southern Leyte, after having been duly sworn to in accordance
with law, do hereby depose and state THAT:

1. I am applying for the position of Public Attorney I at the Public Attorneys Office;

2. As one of the requirements, I have to undergo a Medical Examination such as

Blood Test, Chest X-ray, Urinalysis and Drug Test;

3. I have already submitted my blood sample and urine sample for the above-
mentioned tests, however, the result of such tests would be released on July 8,
2017;

4. I undertake to submit the said documents once available;

5. That I am executing the foregoing instrument to attest the foregoing facts and
circumstances.

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of

________________ at Maasin City, Southern Leyte, Philippines.

DAEL CHURCHILL T. GERONG

Affiant

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

at Maasin City, Southern Leyte, affiant is known to me and exhibited to me his valid
identification card.

Page No. ____; _____________________

Doc. No. ____; Notary Public
Book No. ____;
Series of 2017.