DO NOT PRINT THIS PAGE
INSTRUCTIONS
(Affidavit of Undertaking)
1. There are two (2) affidavits in this document,
namely:
a. Affidavit of Undertaking (for
Patrolman/woman); and
b. Affidavit of Undertaking (for Lateral
Entry);
2. Fill only the Affidavit that correspond or required
for your application. The applicant should not
copy and paste its contents as it is a standard
format.
3. No one is allowed to alter, change, remove or
delete any portion of these affidavits. The
altered affidavits will not affect any violation of
the undertaking under the original affidavits
shown in this document.
4. The applicant must personally fill out the form by
“PDFfiller” (an application available in both iOS
and android), by “Adobe Acrobat Reader DC”
using its “fill and sign” function, or, directly, by
writing by hand above the line provided for the
required data.
5. Both “PDFfiller” and “Adobe Acrobat Reader
DC” are free of charge and this office enjoins or
forbids you to make any in-app purchases.
6. The data to be filled are the following:
a. Under “1”, the city where you subscribed
and sworn the affidavits (inquire if the
notary public can stamp the city on this
portion);
b. Under “2”, your full name, which must be
in the format “First Name Middle Name
WARNING: This is a sworn affidavit. Any falsehood committed is a violation of Revised Penal Code,
which will cause PERMANENT derogatory record at PNPRSS database.
Good Luck on your application.
God Bless.
Surname”. (e.g. Juan Santos Cruz /
Maria Sanchez dela Cruz)
c. Under “3”, your address, which must
include the following details:
(No./Lot/Block/Unit, Street Name,
Barangay, City/Municipality, Province,
Postal Code).
d. Under “4” your signature above your Full
Name. It must be done in own
handwriting and NOT typewritten.
Electronic signature will not be honored.
e. Under “5”, leave it blank and let the
notary public fill this area upon
notarization. (This is subject to the
Notarial Rules and Practices, which will
be enforced by your respective notary
public).
7. After filling the PDF through “PDFfiller” and
“Adobe Acrobat Reader DC” or through own
handwriting, print the same on a Long Bond
Paper (8.5’x13’).
8. After printing, the applicant must cause the
notarization and sign the affidavits in his or her
own hand. Authorized person is not allowed to
sign on behalf of the applicant.
9. Make sure to have the seal of the notary be
marked at the appropriate place on your affidavit
before uploading to PNP Online Recruitment.
10. Submit the original copy of the Affidavits (with
notarial seal) together with other documentary
requirements.
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REPUBLIC OF THE PHILIPPINES )
MUNICIPALITY OF LA PAZ ) s.s.

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Affian
t
SUBSCRIBE AND SWORN to before me this day of at
Philippines.

Doc No. _
Administering Officer
Page No. _
Book No. _
Series No. _
REPUBLIC OF THE PHILIPPINES )
a in the Philippine due to exigency of the
t service;
r 4. I have not been dishonorably discharged, placed
o on AWOL status, dropped from the rolls, or
l dismissed for a cause from the Armed Forces of
w the Philippines, Philippine National Police,
o Philippine Coast Guard, other government
m institution, instrumentality, agency, or
a government owned and controlled corporation;
n 5. I have not been convicted by final judgment of a
) crime involving moral turpitude;
6. I have no pending
I, DEXTER criminal/administrative case in any
HILARION PEREZ of court, tribunal, or quasi- judicial body;
legal age, Filipino, and 7. I have no previous nor present derogatory record
presently residing at P- or medical deficiency which either unintentional
1 PANAGANGAN, LA or intentional through any fraudulent scheme,
PAZ, AGUSAN DEL SUR , machination or any other means, were not
after having duly sworn discovered during the recruitment process;
to in accordance with 8. I shall not contract any loan, insurance
law, do hereby depose plan, pension plan, mutual fund, or
and state that: other investment contract from any
lending, insurance, investment,
1. I hereby confirmed pension or any financial institution
the veracity of my except for a single insurance contract
date of birth and my with the PSMBFI;
civil status; 9. I fully understand that my pregnancy
2. I hereby (for Patrolwomen) during the training
undertake shall cause the termination of my
to serve employment as member of the PNP;
the and
office/unit 10. I hold myself criminally and administratively
where I liable for any false or misrepresentation of facts
am stated in my Personal Data Sheet or other
appointed documents I submitted to the PNP including this
for a Undertaking. The same will also cause the
period of automatic nullification of my appointment as a
10 years; Patrolman/Patrolwoman.
3. I am
willing to That I further certify that the foregoing
be declarations are true and correct to the best of my
assigned knowledge and belief.
anywhere

Affian
t
SUBSCRIBE AND SWORN to before me this day of at
Philippines.

Doc No. _
Administering Officer
Page No. _
Book No. _
Series No. _
 ) s.s.

AFFIDAVIT OF UNDERTAKING
(For Lateral Entry)

I, of legal age, Filipino, and presently

residing at , after having
duly sworn to in accordance with law, do hereby depose and state that:

1. I hereby confirmed the veracity of my date of birth and my civil status;

2. I hereby undertake to serve the office/unit where I am appointed until the date of my
retirement;
3. I am willing to be assigned anywhere in the Philippine due to exigency of the
service;
4. I have not been dishonorably discharged, placed on AWOL status, dropped from the
rolls, or dismissed for a cause from the Armed Forces of the Philippines, Philippine
National Police, Philippine Coast Guard, other government institution, instrumentality,
agency, or government owned and controlled corporation;
5. I have not been convicted by final judgment of a crime involving moral turpitude;
6. I have no pending criminal/administrative case in any court, tribunal, or quasi-
judicial body;
7. I have no previous nor present derogatory record or medical deficiency which either
unintentional or intentional through any fraudulent scheme, machination or any other
means, were not discovered during the recruitment process;
8. I shall not contract any loan, insurance plan, pension plan, mutual fund, or
other investment contract from any lending, insurance, investment, pension or
any financial institution except for a single insurance contract with the
PSMBFI;
9. I fully understand that my pregnancy (for Patrolwomen) during the training
shall cause the termination of my employment as member of the PNP; and
10. I hold myself criminally and administratively liable for any false or misrepresentation of
facts stated in my Personal Data Sheet or other documents I submitted to the PNP
including this Undertaking. The same will also cause the automatic nullification of my
appointment as a Patrolman/Patrolwoman.

That I further certify that the foregoing declarations are true and correct to the best
of my knowledge and belief.