REPUBLIC OF THE PHILIPPINES )

PROVINCE OF NEGROS OCCIDENTAL )

CITY OF SILAY ) s.s.
x ------------------------------------------------------ x

AFFIDAVIT OF UNDERTAKING
I, JOHN JIMENA VILLAVERT, of legal age, Filipino, and a resident of Matagoy St. Brgy. Rizal, Silay
City, Negros Occidental, Philippines, after being duly sworn to, under oath and in accordance with law , do
hereby depose and state that:

1. That I am the owner of Sari Sari Store located at Matagoy St. Brgy. Rizal, Silay City, Negros
Occidental, Philippines

2. That when I applied for a business permit/license to operate, I was advised that I move my
said business five (5) meters from the centerline;

3. That I undertake to voluntarily vacate the encroached property as the necessity arises;

4. That if any part or provision of this undertaking is deemed invalid or illegal, it will be a
ground for the revocation of the permit issued by the City;

5. That this undertaking does not only bind me but also my family and rest who has interest in
the said business

6. That I also undertake to absolve any person, juridical or natural, private or public from
whatever claims, disputes or conflicts and any all liabilities in executing this, hence, I assume
all claims, disputes or conflicts and any and all liabilities

7. That I finally undertake to absolve the City Government of Silay, its employees and
departments/ offices from whatever claims, disputes or conflict in the future hence, I assume
all claims, disputes or conflicts that may arise

8. That I am executing this affidavit to attest to the truth of all the foregoing statements to the
best of my knowledge and facts.

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

, at City of Silay, Negros Occidental, Philippines.

JOHN JIMENA VILLAVERT

affiant

SUBSCRIBED AND SWORN TO before me this in the City of Silay,

Negros Occidental, Philippines, affiants exhibited to me his I.D. No. 33-6060451-2 issued by SSS,Bacolod
City, Negros Occidental, Philippines, bearing his photograph and signature.

WITNESS MY HAND AND SEAL, on the date and place above-written.

Doc No. ;
Page No. ;
Book No. ;
Series of 2023.