REPUBLIC OF THE PHILIPPINES )

Province of Quezon )
City of Lucena ) S.S.

AFFIDAVIT OF UNDERTAKING
I, ___________________________, of legal age, Filipino and a resident of Atimonan,
Quezon, after having been duly sworn to in accordance with law, hereby depose and state:

1. That, I am a resident of Brgy. _____________________, _________________ and

owner of a land adjoining the Road Right of Way of the Provincial Road;

2. That, the _____________________________ through the Provincial Engineering Office,

will implement the Provincial Road Improvement Project which will expand the current
Road to TEN (10) Meters wide;

3. That, upon verification survey, it was determined that I have an existing Coconuts,
Plants, Trees and Structures (CPTS) within the Provincial Road Right of Way and the
affected CPTS is outside my property line and has encroached the Provincial Road Right
of Way;

4. That, I interpose no objection to the removal or demolition of any Coconuts, Plants, Trees
and Structures (CPTS) within the Provincial Road Right of Way;

5. That, further, I hereby pledge and commit to remove or demolish on my own account any
Coconuts, Plants, Trees and Structures (CPTS) that will be affected by the Road
Widening Project upon signing of this Affidavit of Undertaking;

1. That, furthermore, I swear and guarantee to allow officials and employees of the
______________________, its contractors, agents and assigns access to all necessary
locations at the Site for the purpose of conducting and overseeing construction activities
at the premises, including site surveys, groundbreaking and others.

6. As such, I am executing this Affidavit to attest to the truth of the foregoing and for
whatever legal purposes this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

_______________________ in Atimonan, Province of Quezon.

_____________________________
Affiant
Valid ID No. __________________
Issued by_____________________

SUBSCRIBED AND SWORN to before me a Notary Public for and in the Province of
Quezon, this ________________ , at _______________________.

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