BPI EMPLOYEES UNION – METRO MANILA

23F, BPI Buendia Center Bldg., Makati City

Tel. No. 09663379954
Reg. Cert. No. 10382-LC
 
STATEMENT OF UNDERTAKING

I, ___Ryan G. Rull______________________________, a bona fide member of Bank of P. I. Employees Union,

presently assigned at ______New Alabang Branch_______________________ hereby advises the Union that I
am diagnosed as covid positive on _____July 29, 2021______________________.

In view thereof, may I request the Union to extend to me or to my designated beneficiary the
emergency assistance as provided for under our Relief Program.

As a condition to the payment of said emergency assistance, I hereby undertake to present/submit

to the Union within fifteen (15) days from receipt of the emergency financial aid the required
certificate for authentication/verification of the Relief Committee.

I also acknowledge the fact that failure on my part to submit the aforesaid documents within the
prescribed time shall cause delay in the collection of relief contributions being assessed from
members through automatic salary deductions.

Moreover, in the event that the Relief Committee who is in charge of investigating and/or
confirming this report found that the above-named is not in any way within the scope of coverage
under the Program, I likewise undertake to refund the Union the amount advanced to me or my
designated beneficiary and reimbursing the Union is without prejudice to any disciplinary action
that the Union may take or institute against me.

In witness whereof, I have hereunto affixed my signature this ____ day of _________________ 20__ at
Metro Manila.

Savings Account No. :_____________________

Employee No. :_____________________ ______________________________________

Mobile No. :_____________________ (Signature over Printed Name)

CERTIFICATION

We, the undersigned employees of Bank of the Philippine Islands (BPI) hereby certify the veracity
of the above-stated claim of Union member ______________________________________relative to the recent
calamity.

This certification is being issued/done as a requisite for the immediate payment of the emergency
financial assistance to subject employee of his/her designated beneficiary as provided for under the
Union’s Relief Program.

In witness whereof, we have hereunto affix our signatures this _______ day of ___________________
20_____ at Metro Manila.

______________________________________               _________________________________________
(Signature over Printed Name)               (Signature over Printed Name)