Republic of the Philippines)

Province of Masbate )
City of Masbate )
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AFFIDAVIT OF UNDERTAKING

I, MYRA V. LACSON, as duly authorized representative of the Masbate

Provincial Hospital of the Province of Masbate, of legal age, married, Filipino and a
resident of Brgy. Nursery, Masbate City, Masbate, Philippines, after having sworn in
accordance with law, do hereby depose and state:

1. That I am currently holding the position of Nutritionist- Dietitian III but

designated as Assistant Compliance Officer in the Administrative Office of
the Masbate Provincial Hospital, Masbate City, Masbate;

2. That the Provincial Engineering Office of the Local Government Unit of the
Province of Masbate was in custody of the Floor Plan Level ONE (1) and
TWO (2) of the new hospital building of the Masbate Provincial Hospital;

3. That by reason of change of administration of the Local Government Unit of

the Province of Masbate and the concurrent change of administration in the
Provincial Engineering Office, said Floor Plan Level ONE (1) and TWO (2)
of the new hospital building got lost during the transition;

4. That there exists a duplicate copy of the Floor Plan Level ONE (1) and TWO
(2) of the new hospital building in the Department of Health (DOH) Central
Office, Manila;

5. That I undertake to facilitate the request for the issuance of a copy of said
Floor Plan Level ONE (1) and TWO (2) of the new hospital building before
the DOH Central Office;

6. Further, I undertake to produce and submit to the DOH Regional Office V

said copy of the Floor Plan Level ONE (1) and TWO (2) of the new hospital
building once my request for the issuance and release of such be granted by
the DOH Central Office;

7. As such, I am executing this affidavit to attest to the foregoing facts and for
whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 10th day of

October, 2019 in Masbate City, Philippines.

MYRA V. LACSON
Affiant

SUBCRIBED AND SWORN TO before me this 10th day of October, 2019 in

Masbate City, Philippines, affiant exhibiting to me his/her valid proof of identification.

MA. THERESA A. LEGASPI- VALENCIA

Public Attorney II
Pursuant to R.A. 9406
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2019.