REPUBLIC OF THE PHILIPPINES

PROVINCE OF CAVITE
DASMARIÑAS CITY
AFFIDAVIT OF UNDERTAKING
I, ________________________, Filipino, of legal, married and resident of lot 21 Block 11 K1, DBB,
Dasmariñas Cavite, represented by her Attorney-In-Fact, ____________________, after being duly
sworn to in accordance with law, depose and state: That

1. I am the owner of a parcel of land located at ____________________________ with a total area of

_____________________ and with improvements containing a floor area of _______________;

2. In connection with my application for occupancy permit for Four (4) Storey Residential Building
(Dormitory) whereas Wet Standpipe devise is required by the bureau of Fire Protection prior to the
issuance of occupancy permit. Attached herein is an installation Contract for the wet Standpipe System;

3. I hereby request the issuance of Fire Safety Inspection Certificate prior to the completion of the
installation of ___________________;

4. Through this Affidavit I hereby declare under oath not to hold liable the Bureau of Fire protection and
other interest criminally, administratively and civilly for any occurrence that may happened during the
period of installation;

5. I am executing this Affidavit to attest to the truth and veracity of the foregoing and for whatever legal
purpose the same may serve;

6. Furthermore, the personnel and staff of the said station will not be liable criminally and
administratively if any fire incident happened on the establishment. And that the Fire Safety Inspection
Certificate that will be issued to my business will be nulled or void if the tenants do not apply and
comply the requirements within six (6) months from this date.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 23th day July 2015 in Dasmariñas City,
Cavite

JESUS GEMEDTIZA
Affiant
Represented by herb Atty-in-Fact

CONCEPTION B. MENDOZA

SUBSCRIBE AND SWORN to before me this 23th of July, 2015 affiant exhibiting to me her
PAAPORT # EB2086325 ISSUED On 03.14.11 at PE ATHENS.

ATTY. JAMES M.I

Notary Public
Until December 31
REPUBLIC OF THE PHILIPPINES
PROVINCE OF CAVITE
DASMARIÑAS CITY
AFFIDAVIT OF UNDERTAKING

I, _____________________________________, Filipino, of legal, married and

resident of ________________________________________________ after being duly
sworn to in accordance with law, depose and state; That

1. I am the registered owner of a Three (3) storey commercial bldg. located at

________________________________________________________________,
with a estimated total lot area of _____ square meters and with improvements
containing a estimated floor area of _____ sq. meters;

2. In connection with my application for business permit for

_______________________________________________ whereas the fire
safety equipment required by the Bureau of Fire Protection prior to the issuance
of business permit will be complied by our lessee. Herein is the list of the lessee
and their businesses;

Name of Lessee Business Name

3. I hereby request the issuance of Fire Safety Inspection Certificate.

I am executing this Affidavit to attest to the truth and veracity of the foregoing
and for whatever legal purpose the same may serve;

Furthermore, the personnel and staff of the Bureau of Fire Protection will not be
held liable criminally and administratively if any fire incident happened on the
establishment. And that the Fire Safety Inspection Certificate that will be issued to my
business will be null or void if the tenants do not apply and comply with the
requirements within a month from this date.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

________________________in Dasmariñas City, Cavite.

________________________________
Affiant

SUBSCRIBE AND SWORN to before me this _______ of November 2022,

Affiant exhibiting to me her __________ ISSUED On ___________ at ___________.