Republic of the Philippines )

) S.S.

AFFIDAVIT OF UNDERTAKING
I, , of legal age, Filipino citizen, and a
resident of , after being duly sworn to, under oath
and in accordance with law, do hereby depose and state that:

1. I am the school head of _________________________________ located at _______________________________;

(Name of School) (Address)

2. To participate in the progressive expansion of the face-to-face learning modality, I have

accomplished the revised DepEd School Safety Assessment Tool (SSAT) where all
required indicators were met by the school;

3. The school has secured support from the LGU (Municipality/City) in the form of a
resolution or letter of support allowing schools to participate in face-to-face classes;

4. The learners who will participate in face-to-face learning modality have signed parent
consent forms;

5. The school will only implement face-to-face learning modality under Alert Level 1 or 2
or the equivalent classification based on the latest national guidelines;

6. Pursuant to the DepEd–DOH Joint Memorandum Circular (JMC) titled Revised

Operational Guidelines on the Progressive Expansion of Face-to-Face Learning Modality,
the following documents are hereby submitted to the DepEd Regional Office with
jurisdiction over the area where the school is located:

a. Formal Letter addressed to the Regional Director, copy furnished the Schools
Division Superintendent of the area where the school is located, stating the
following:
o Intent to implement face-to-face classes;
o Commitment to observe the minimum health and safety protocols as
stipulated in DepEd-DOH JMC No.1, s. 202l and other applicable
issuances;
o Willingness to submit a report on lessons and recommendations on a
quarterly basis for the implementation of face-to-face classes.
b. Implementation Plan including the timelines following the four components of
the operational framework, namely: (i) Safe Operations, (ii) Teaching and
Learning, (iii) Including the Most Marginalized, and (iv) Well-being and
Protection;
c. Contingency Plan showing action points to address contingencies that might
occur during implementation;
d. Accomplished SSAT showing compliance with all indicators of the SSAT;

7. I am aware that I may be held liable for any false statement or misrepresentation made
in this document or in any other documents relative to the school’s submission;

8. I am executing this affidavit to comply with all applicable rules and regulations on the
conduct of face-to-face classes, and to assume responsibility for the school’s
implementation of the same; and

9. I attest to the truthfulness, veracity, and due execution of the foregoing statements and
this document.
 IN WITNESS WHEREOF, I hereunto affix my signature this day of 20 , at
.

______________________________________
Affiant

SUBSCRIBED AND SWORN TO before me this day of , 2022 at

, affiant having exhibited to me his/ her _______________________________
with nos. _________________.

Doc No. _____

Page No. _____
Book No. _____
Series of 20_____.