REPUBLIC OF THE PHILIPPINES )

LEGAZPI CITY, ALBAY ) S.S.

AFFIDAVIT OF UNDERTAKING

I, _________________, of legal age, single, Filipino, and a resident of

_________________, after being sworn to in accordance with law, hereby depose and state
that:

1. I am the supervisor and authorized representative of _________________, with

business address at _________________;

2. As such, _________________ hereby undertakes to construct and provide the

necessary installations, particularly, the Secondary Exit and Fire Alarm and
Detection System (FDAS);

3. The Affiant will accomplish the afore-stated requirements and requests for an
extension of six (6) months from the 3rd week of August 2021, or until the 3rd
week of February 2022;

4. I am executing this Affidavit for the purpose of applying for a Fire Safety Inspection
Certificate (FSIC) for Business Permit and to attest to the truth of the foregoing
statements and for whatever legal purpose/s it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 19 th day of July 2021 at Legazpi
City, Albay.

_________________
Affiant

SUBSCRIBED AND SWORN to before me this 19th day of July 2021 at Legazpi City, Albay,
affiant exhibited to me her _________________, as competent evidence of her identity.