PRM RSD FORM 2015-01-C

Republic of the Philippines

National Police Commission
NATIONAL HEADQUARTERS, PHILIPPINE NATIONAL POLICE
Camp Crame, Quezon City

AFFIDAVIT OF UNDERTAKING

JEMPOL DOHILLO PATEREZ N/A

I, ____________________________________________________, of legal age,
Filipino, (First Name) (Middle Name) (Last Name) (Qualifier)

presently residing at _________________________________________________after

GREENVILLE BATO, BRGY. RIZAL, SAN CARLOS CITY, NEG. OCC.
having, been duly sworn to in accordance with law, do hereby depose and state that:

1. I am an applicant for this CY___________________

2021 UNFILLED QUOTA Pat/Lateral Entry Program
(Line/Technical Officers) recruitment program;

BACHELOR OF SCIENCE IN CRIMINOLOGY

2. I am a graduate of _________________________________________________
(Degree/Course)
and holder of _________________________________________
RA 6506 eligibility;

3. I was born on ____________________

NOVEMBER 23, 1995 (Month/Day/Year format) as appearing in my
______________________(Proof
BIRTH CERTIFICATE of Birth e.g. NSO issued Birth
Certificate/Local Registry Birth Certificate), and that I am hereby notified that my
declared birth date indicated herein shall become incontestable in so far as my
service in the PNP is concerned after the lapse of six (6) months from the effectivity
of my appointment;

4. That in the event that I will file a petition to alter or correct entries in my birth records
before any court or the CSC, I hereby undertake to first inform the DPRM (Attn: C,
RMD) before filing the same; and

5. That I am aware that any misrepresentation, omission, or misdeclaration of my birth

date committed during the initial recruitment/appointment process, or finding that I
entered the service below the minimum or above the maximum allowable age at the
time of my appointment, without the necessary age waiver shall be a ground for the
filing of an administrative case/institution of termination proceedings for dishonesty,
as applicable, as well as the filing of criminal charges for perjury.

JEMPOL DOHILLO PATEREZ

_____________________________
Affiant

SUBSCRIBED AND SWORN TO before me this ____ day of _______________,

20___, at ____________________________, Philippines.

________________________
(Notary Public)

Doc:________
Page:_______
Book:________
Series of ______
 Republic of the Philippines)
)
) . . .s.s.

AFFIDAVIT OF CONFIRMATION

JEMPOL DOHILLO PATEREZ

I, ______________________________________, a Filipino of legal age, a resident of
___________________________________,
BRGY. RIZAL, SAN CARLOS CITY, NEG. OCC. a bona fide member of the Philippine
National Police with the rank of _____________
PATROLMAN and presently assigned at
______________
NSU-MARITIME GROUP after having been duly sworn to in accordance with law, do hereby
depose and says that:

1. Pursuant to this affidavit, I am confirming that the following are my legal

beneficiaries and/or heirs, to wit:

NAME RELATIONSHIP BIRTHDATE

12/07/1999
MYLENEWIFE
___________________________
MELMIDA PATEREZ _____________ __________
JAMES SON
DAVEY M. PATEREZ
09/16/2020
___________________________ _____________ __________
___________________________ _____________ __________
___________________________ _____________ __________
___________________________ _____________ __________

2. My relationship with persons whose names are listed above are borne out by
the fact that I am the lawful spouse and the legitimate/illegitimate
father/mother of the afore-named children as evidenced by the attached
marriage contract and birth certificates:

3. I hold myself criminally and administratively liable for perjury and dishonesty
should any statements made herein are inaccurate or later on found to be
false and in of law.

AFFIANT SAYETH NAUGHT:

JEMPOL DOHILLO PATEREZ

_________________________
Affiant

SUBSCRIBE AND SWORN to before me this ____ day of _____________ at

________________________ Philippines.

Doc No. _________

Page No. _________
Book No. _________
Series No. _________
DPRM RSD FORM 2015-01-D
Republic of the Philippines
National Police Commission
NATIONAL HEADQUARTERS, PHILIPPINE NATIONAL POLICE
Camp Crame, Quezon City

AFFIDAVIT OF UNDERTAKING
(Incontestability of Declared Birth Date)

JEMPOL DOHILLO PATEREZ N/A

I, ____________________________________________________, of legal age, Filipino,
(First Name) (Middle Name) (Last Name/Qualifier)
presently residing atGREENVILLE
_________________________________________________after
BATO, BRGY. RIZAL, SAN CARLOS CITY, NEG. OCC. having
duly sworn to in accordance with law, do hereby depose and state that:
BACHELOR OF SCIENCE IN CRIMINOLOGY
1. I am a graduate of _________________________________________________ and
(Degree/Course)
RA 6506
holder of ___________________________________________ eligibility;

2. I was born onNOVEMBER 23, 1995

____________________ and that my declared birth date indicated
therein shall be uncontestable six months after submission to RMD, DPRM;

3. Any doubtful application of changes, adjustment for any purpose whatsoever shall
be automatic ground for denial;

4. I have not been dishonorably discharged from military employment or on Absence

Without Official Leave or Dropped from PNP Rolls or dismissed for cause from any
civilian position in the Government;

5. I have no previous appointment in the PNP as well as proof of record of resignation

in any uniformed government service. The discovery thereof, in any stage of
validation, attestation and confirmation of appointment as Patrolman/Patrolwoman
shall not prejudice the PNP to cancel, revoke, recall and/or subsequently nullify
anytime the appointment order and corresponding attestation;

6. I have no pending criminal and/or administrative case in any court, administrative

and quasi-judicial bodies including Office of the Ombudsman;

7. I have not been convicted by final judgment of an offense or crime involving

falsification of documents, perjury and moral turpitude;

8. Any fraudulent entry therein shall be a ground for the filing of a criminal and
administratively case for perjury, falsehood, misrepresentation or omission or act of
dishonesty or for any fraudulent, falsification or tampered documents that I have
submitted;

9. I have read and checked all the entries appearing in my Personal Data Sheet (PDS)
and that I certify that all entries thereof are true and correct;

10. I further certify that the foregoing declarations are true and accurate to the best of
my knowledge and ability and I hereby authorized the PNP to obtain and secure
pertinent records that will show my qualification standards, collateral requirements
and case records and other record related to this declaration if any, in any agency or
office.

That I attest to the truthfulness of the foregoing declaration and submit myself to the
legal consequences thereof, if ever the statements above are wanting in truth and in substance.

JEMPOL DOHILLO PATEREZ

_____________________________________
Affiant

SUBSCRIBED AND SWORN TO before me this ____ day of _______________, 2020, at

____________________________, Philippines.

_______________________________
(Notary Public)