REPUBLIC OF THE PHILIPPINES)

QUEZON CITY ) SS

AFFIDAVIT OF UNDERTAKING

The undersigned, _____________, of legal age, with office address at

____________________, after having been duly sworn on oath in accordance with law,
here voluntarily depose and say:

That the undersigned is the authorized representative of ___________________,

and the grantee of a Certificate of Public Convenience to Operate a
__________________ under case number/s _________________, which is authorized to
operate on the route: __________________, which certificates are valid and existing up
to _______________________________.

That __________________, shall be operating this period of

_______________________ by virtue of ______ issued by this Honorable Board
pursuant to Memorandum Circular No. ____________ and subsequent related
issuances, particularly Memorandum Circular No. ___________, opening the above-
mentioned route;

That the undersigned affiant UNDERTAKES to faithfully comply with the above
stated issuance/es;

That non-compliance or violation of this undertaking shall be subject to penalty

under Joint Memorandum Circular No. _______________.

I am executing this statement to attest to all above facts.

IN TRUTH WHEREOF, I have hereunto signed by name below, this, ___th day of
December, 2021 at Quezon City.

Affiant

Subscribed and sworn to before me this ____th day of _________________,

affiant exhibited to me his _______________ expiring on _________________.

Doc. No. _____

Page No._____ Notary
Public
Book No._____
Series of 2021.