AFFIDAVIT OF UNDERTAKING

I, CHERRY JANE BACCAY DELA CRUZ of legal age, Filipino, widow, with
residence and postal address at Block 10 Lot 49, Vista Del Rio Subdivision, NHA,
Alimannao, Peñablanca, Cagayan, after having been swear to in accordance with the
law, depose and state:
1. That I am the LEGAL BENIFICIARY/CLAIMANT of BONIFACIO GADIANO
DELA CRUZ JR, principal member of ________________________________
for the total savings/additional benefit;

2. That I am now claiming the benefits proceeds due to his untimely death;

3. That I have understood the consequences as explained to me by the officer

and/or staff of _______________________________ as to the release of the
benefit check in my favor;

4. That I hold _________________________________ FREE from any liability,

civil or criminal, or whatever nature that will arise from any third party claim in
relation to the release of the check/s in my favor;

5. That I hold myself liable if ever disallowances will occur in this claim in the
absence of concrete/complete documents from
_________________________________.

6. That I HOLD myself solely responsible for any liability, civil or criminal, or nature
that will arise in connection with the release of the benefit claims/check of
BONIFACIO GADIANO DELA CRUZ JR in my favor.

7. That I am executing this affidavit to attest to the truth of the foregoing facts and
for whatever legal purpose or intent this may duly serve.

IN WITNESSED WHEREOF, I have hereunto set my hand this __________day of

_____________, 2019 at ____________________________________________.

__________________________
Affiant

REPUBLIC OF TH PHILIPPINES
PROVINCE OF ______________) S.S.
CITY/MUN. OF ______________)

SUBSCRIBED AND SWORNED TO before me this _________ day of

______________, 2019 at ______________________________________. Affiant
exhibited to me his/her Community Tax Certificate No: _________: issued at
_______________________, issued on _____________________.

__________________________
Notary Public