Republic of the Philippines )

Quezon City ) S.S.

AFFIDAVIT OF UNDERTAKING

I, ______________________, of legal age, single, Filipino, with address at

____________________ after having been duly sworn in accordance with law, hereby depose and
state:

1. That I am applying for Building Permit for the One (1) unit / Two (2) Storey Residential
Building, located at ___________________ with Application No. __________________;

2. That, I hereby certify that the above-mentioned project shall be undertaken by administration
and not by contract; and

3. That this affidavit is being executed in lieu of the required duly accomplished Notice of
Construction Form (NBC Form B-20) of the Quezon City Department of Building Official,
provided under NBCDO Memorandum Circular No. 03, Series of 2017, for the issuance of
Building Permit for the above-mentioned project.

AFFIANT FURTHER SAYETH NAUGHT.

Done this ____ day of _________________.

Applicant

SUBSCRIBED AND SWORN to before me this at Quezon City affiant

exhibiting to me her Driver’s License ___________ and valid until _____________.

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