Republic of the Philippines )

___________ )S.S.

AFFIDAVIT OF UNDERTAKING

I, _____________, Filipino, of legal age, with office address at ______________________________, do

hereby depose and say:

That, I am the President of _________________________, a corporation duly organized and existing

under Philippine Law;

That, on _______________, our company imported the following goods that arrived at the Port of
_____________

Goods :
CONSIGNEE :

That, we undertake to submit the permit from the FDA once its released;

That, I am executing this Affidavit of Undertaking to attest to all the truth of the foregoing facts and for
whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set may hand this ___ day of ________ in __________.

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this ____ day of _______. Affiant exhibiting to me his Tax
Identification Card No. ___________________.

Doc. No.________;
Page No. _______;
Book No. _______;
Series of 2022.