REPUBLIC OF THE PHILIPPINES)

Province of Bukidnon) S.S.

Municipality of Don Carlos
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AFFIDAVIT OF UNDERTAKING
I, _____________________, Filipino, married, of legal age, and resident of
____________________, Bukidnon, Philippines, having been duly sworn to in
accordance with law, hereby depose and state that:
1. I am one of the member of ___________________ with account
No__________________;

2. I have an outstanding balance with the said cooperative in the amount of

__________________________ (_______________________) inclusive of
interest, fines and atty’s fees;

3. I undertake to pay such obligation in an amount of

________________________ (________________) every month starting
this 30th day of July 2020 for 120 months;

4. I am aware that I may be criminally liable for any false statement or

representation made in this document or for any other documents submitted
in connection with this affidavit;

5. That I am executing this affidavit to attest the truthfulness, veracityand due

execution of the foregoing statement and for whatever legal purpose it may
serve.
WITNESS WHEREOF, I have set my hand this 15 th day of July 2020 at the
Municipality of Don Carlos, Bukidnon.
______________________
Affiant

SUBSCRIBED AND SWORN TO before me this 15 th day of July 2020 at the Municipality of Don Carlos, Bukidnon. Affiant
personally appeared known to me and to me known to be the same person who executed the foregoing instrument.