REPUBLIC OF THE PHILIPPINES]

BUTUAN CITY ] s.s.

AFFIDAVIT OF UNDERTAKING

I, ______________ of legal age, Filipino, married and a resident of ___________, Butuan City, Philippines, after
having been duly sworn to an oath in accordance with law, hereby depose and state that:

1. I acknowledge, affirm, and/or confirm that I failed to comply with the requirement of securing a Certificate
of Occupancy / Occupancy Permit from the City Architect’s Office and/or Office of the Building Officials,
subject to imposition of administrative fines, penalties, and/or surcharges under the implementing Rules
and Regulations of Presidential Decree No. 1096;
2. I shall process, submit the requirements of, and secure the Certificate of Occupancy / Occupancy Permit
from appropriate city government office(s), agency(ies), and/or department(s) before September 01,
2021;
3. I shall fully cooperate with the city government in the inspection and evaluation of my building/structure
where my business is being conducted;
4. I hereby waive all rights and privileges in my business permit if fail to comply with the requirements of
Certificate of Occupancy / Occupancy Permit before September 01, 2021, subject to imposition of
administrative fines , penalties, and/or surcharges under the Implementing Rules and Regulations of
Presidential Decree No. 1096;
5. I shall comply with all existing laws, ordinances, and regulatory requirements mandated by law for the
operation of my business, and I understand that I may be held criminally, civilly, and/or administratively
liable for violations of any law or ordinance;
6. Any violation of this undertaking shall result in imposition of fines and/or penalties as provided by law, or
warrant the suspension, cancelation, or revocation my Mayor’s/Business Permit, and I shall not oppose
the closure of my business as a result thereof;
7. If I fail to comply with this undertaking after the September 01, 2021 deadline imposed by the City
Government of Butuan, I shall voluntarily cease and desist from my business operation.
8. I am executing this Affidavit to attest to the truth of the foregoing and for whatever legal purpose this
maybe this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 27 th day of January 2021 at Butuan City,
Philippines.

__________________
Affiant

SUBSCRIBED AND SWORN TO before me, this ____________________ at Butuan City, Philippines. Affiant
appeared to me and exhibited TIN 249-486-580 as competent evidence of her identity.
Doc. No. _______:
Page No. _______:
Book No. ______:
Series of 2021.