REPUBLIC OF THE PHILIPPINES)

CITY OF __________________) S.S.

AFFIDAVIT OF UNDERTAKING

I, EDGAR G. REQUILME, Filipino, single/married, a registered and licensed

SOCIAL WORKER (profession), with address at LESSANDRA HEIGHTS, GRAN
EUROPA, CAGAYAN DE ORO CITY after having been duly sworn in accordance
with law hereby depose and state that:

1. I applied for the renewal of my Professional Identification Card

(PIC) with the Professional Regulation Commission;

2. As requirement for the renewal of my PIC to date, I have to

submit proof of ___ (number of) CPD Credit Units in compliance
with Republic Act (RA) No. 10912 or the Continuing Professional
Development Act of 2016, and its Implementing Rules and
Regulations (IRR) on the next renewal of my PIC;

3. Due to ______________________________________________,
(state reason), I failed to comply with the required CPD credit
units. Attached herein is/are ___________________________
(proof or evidence, if any).

4. I undertake to comply with the required ____ CPD credit units

during the validity of my PIC in additional to the required _____
CPD Credit Units for the subsequent renewal period;

5. I will submit proof of my compliance with ____ total number of

CPD Credit Units during the next renewal of my PIC:

6. I understand that in the event I fail to submit compliance with the

required total number of CPD Credit Units, I cannot renew my PIC
on the next succeeding renewal periods;

7. I am executing this affidavit to attest to the truth and veracity of

the foregoing statements for whatever legal purpose it may
serve;

8. AFFIANTS FURTHER SAYETH NAUGHT.

EDGAR G. REQUILME
Affiant

SUBSCRIBED AND SWORN to before me this __ day of ______2019, at

___________, Philippines, affiant exhibiting to me his/her
________________(valid issued government Identification Card) issued on
__________ at ___________.

Doc. No._______
Page No._______
Book No._______
Series of 2019