Republic of the Philippines)

City of Bacolod - - - - - - - - )Sc.

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AFFIDAVIT OF UNDERTAKING

I, _________________________, of legal age, Filipino citizen, married and a

resident of __________________________ Bacolod City, Negros Occidental,
Philippines, after having been sworn to in accordance with law, do hereby
depose and say:

I am the Owner of ________________lumberyard and hardware a single

proprietor business with business address at ________________ Bacolod City,
Negros Occidental.

_______________________ is engaged in the fabrication of furniture and

supply of lumber products with DENR Permit No. ____________________.

My woodcraft business has not caused nuisance in the area for I have
been compliant with the requirements required by all concerned offices with
regards to its operation.

With regards to health issue, I have complied with the sanitary permit to
operate with permit No. ______________, and complied with its mandate. I am
also compliant with the Barangay Ordinances that covers the operation of my
woodcraft business and has not received complaint from the Barangay as
evidenced of the Barangay Certification.

As the owner of _________________lumberyard and hardware , I hereby

represent, warrant and undertake that I shall comply with the requirements
from all concerned agencies and shall take responsibilities to whatever
complaint that will transpire in the future with regards to the operation of my
woodcraft business and shall not hold the City Health Office of Bacolod City
accountable;

I execute this affidavit of undertaking in order to attest to the truth of the

foregoing facts and for whatever legal purposes and intents this may serve.

IN TRUTH AND WITNESS WHEREOF, I have hereunto set my hand this

_______ day of __________ 2021 in the City of Bacolod, Philippines.

_________________________
BEFORE ME this ______ day of _________ 2021 in the City of Bacolod,
Philippines personally appeared ____________________with his Competent ID No.
______________________ issued on ______________ at __________________ known to
me to be the same person who executed the foregoing instrument and
acknowledged to me that the same is his free and voluntary act and deed.

Witness my hand seal.