ANNEX “3” REPUBLIC OF THE PHILIPPINES. CITY/IMUNICIPALITY OF. 8.8 AFFIDAVIT OF UNDERTAKING |, (Name of Geodetic Engineer), of legal age, single/married, duly licensed Engineer with PRC. ID No. Filipino and residing and with postal / business address at after having duly swom to in ‘accordance with the law, depose and say: 1. That | am duly engage to gather the survey data for the proposed Te ag jeter-high PTT of, the applicant / proponent, (Name of Tower Company), a duly organized corporation or company with business / postal address al (Complete Malling Address of the Proponent); 2, That after the conduct ofthe actual survey, the following information was gathered: ‘a. Address of the site for the proposed PTT! construction is at (Lot Number with Survey ‘Number, Street Name, Barangay, District, City or Municipality, Province); b. The coordinates, in World Geodetic System of 1984 (WGS-84), of the site for the ‘(Latitude and Longitude in degrees-minutes- ‘proposed Shared PTT! construction are. seconds); . The ground elevation, in Earth Gravitational Model 2008 (EGM2008), ofthe site for the Proposed Shared PTTI construction is (Site Elevation at Ground Level in meters); 4. The site of the proposed Shared PTTI construction is outside the CAP Critical Areas (attached the map or approved location}; 3. 11am executing this undertaking to attest tothe truth of ail the foregoing in compliance to the inter-agency Joint Memorandum Circular No. 01° series of 2020. IN WITNESS WHEREOF, | have hereunto signed this Undertaking, this ___ day of , in the City of, Philippines. {Signature of the Geodetic Engineer} ‘Name of the Geodetic Engineer PRC Registration Number: PTR Number: ‘Streamlined Guidelines for the Issuance of Permits, Licenses, and Certificates for the Construction of Shared Passive Telecommunications Tower Infrastructure (PTTIs). a7ANNEX “ REPUBLIC OF THE PHILIPPINES) CITY OF Ss JOINT CERTIFICATION h the owner of the building located at ‘Which has been existing fora period of ___years, -and- 1, Engr, a GivilStructural Engineer, was hired by the above Stated owner of the aforesaid siructure, to conduct a comprehensive evaluation and testing of the structural stability and to ensure the buikiing safety for human habitation. After the said extensive evaluation and testing conducted on t have found the subject structure above state, to be structurally stable and complaint with the other requirements mandated by P.D. 1096, otherwise known as the National Building Code of the Philippines. Further, the structural framing of the above stated structure consisting of beams, columns, and {footings are adequate enough to hold the whole structure, structurally safe and sound. ‘As to construction-wise, physical feature and appearance’ of the structure shows good ‘construction method was employed and material used were good qualty and standard. We hereby certify to the truthfulness and veracity of the above stated paragraphs, and that we jointly assume any civil and/or criminal liability in case of structural failure, collapse, and damage within the next ten (10) years. IN WITNESS WHEREOF, we hereunto set our hands this _day of. at city, ‘Affiant (Owner) ‘Affiant (Engineer) 1D, 1D.No. Issued on Issued At ‘SUBSCRIBED AND SWORN to before me this__day of __, 20__at Affiant exhibiting to me his valid govemmentissued identification no, Tssued at ‘and valid unt Notary Public until 31 December 20__ PTRNo. Doc. No. Page No. ‘Book No. Series of 26