REPUBLIC OF THE PHILIPPINES

CITY/MUNICIPALITY OF _________________) S.S.

AFFIDAVIT OF UNDERTAKING

I, ___________________________________________, of legal age, _______ and a resident of

_________________________________ after having been duly sworn to in accordance with the law,
depose and say:

1. That I am the authorized representative of _________________________________for

the application of demolition permit of the building located at
________________________________________________.

2. That I undertake to submit Certificate of Construction Safety Health Program, and other
documents or clearances from government authorities as maybe provided by local
ordinances and/or national laws to the Office of the Building Official (OBO) within 30
calendar days.

3. That I executed this affidavit of undertaking for and in behalf of the project’s contractor.
Default or failure to submit documents/clearances after 30 calendar days shall subject to
the suspension of construction and imposition of penalty. Failure to submit
documents/clearances shall be dealt with in accordance to Section 306 of the NBCP.

4. That I informed the Neighbors (Left Side, Right Side and Rear Side) of the said property
of the proposed construction.

5. That I further executed this undertaking to attest to truth and veracity of the foregoing
statements and for all legal intents and purposes.

IN WITNESS WHEREOF, I have hereunto affixed my signature this __________ day of

________________, 20____.

______________________________
Name of Applicant

SUBSCRIBED and sworn to before me, this ______ day of _____________, in the City/Municipality
of ________________ by _______________________________ with
______________________________ (Proof of Identification/ Identification Number), issued on
________________________________ at _____________________________.

Doc. No. _________:

Page No._________:
Book No._________:
Series of _________: