REPUBLIC OF THE PHILIPPINES)

MUNICIPALITY OF ____________)
PROVINCE OF _______________)

AFFIDAVIT OF UNDERTAKING

I, ______________________________of legal age, Single/Married, Filipino Citizen, and a

resident of _________________________________________, after having been sworn to in
accordance with law, do hereby depose and state that:

1. I am presently applying for employment as Fire Officer 1 in the Bureau of Fire Protection,
Region 1;

2. In support of my said application, I submitted the following documents to BFP Region 1, to

wit;
a. Application Letter
b. Personal Data Sheet (CSC Form 212)
c. Transcript of Record and Diploma
d. Certificate of Eligibility
e. NSO Birth Certificate
f. Valid Local Clearances
i. Barangay Clearance
ii. Mayor’s Clearance
iii. Police Clearance
iv. Municipal Trial Court (MTC)/ Municipal Circuit Trial Court (MCTC)/ Municipal
Trial Court in Cities (MTCC) Clearance
v. Fiscal or Prosecutor’s Clearance
vi. Regional Trial Court (RTC) Clearance
vii. National Bureau of Investigation (NBI) Clearance
g. Driver’s License
h. Certificate of Waiver for Age and Height

3. I hereby undertake that the above listed documents are authentic copies of the originals,
complete and all statements and information provided therein are true and correct;

4. Further, I authorize the Appointing Authority of BFP-Region 1 or his duly authorized

representative to verify the genuineness and due execution of all the documents submitted;

5. I understand and accept that any false statement in this respect will render me liable for
prosecution to the full extent of the law;

6. This affidavit is made to attest the veracity of the foregoing statements and for whatever
purpose it may serve.

IN WITNESS HEREOF, I have hereinto set my hand this ____ day of _______, 2016 in the
Municipality of ____________, __________________, Philippines.

___________________________
Affiant

SUBSCRIBED and SWORN to before me, a Notary Public for and in _________ in the
Municipality of ________________ this ______ day of __________ by the above Affiant,
_________________________ who satisfactorily proven to me his/her identity through his/her
_______________, bearing ID No. ________________ valid until ______________, that he/she is
the same person who personally signed before me the foregoing Affidavit, acknowledge that he
executed the same and that the same is his free act and deed.

Doc No. ______;

Page No. _____;
Book No. _____;
Series of 2016.