REPUBLIC OF THE PHILIPPINES }

CITY OF TAGBILARAN }

AFFIDAVIT OF UNDERTAKING

I, ___________________, Filipino, 63 years old, married and a resident of

______________________, after being duly sworn to in accordance with the law,
do hereby say that:

1) I am the niece of ______________, who died more than ten years ago,
and without children and whose husband pre-deceased her;
2) The said ________________, during her lifetime, has a registered water
service connection of ______________________ in her residence at
________________________;
3) Upon her death, I assumed her water service connection as above-
mentioned, paying the monthly bills;
4) Due to financial constraints, I am now requesting BWUI to disconnect
the aforementioned water service connection in the name of
______________________ as I have a registered water service
connection in the same company under my name;
5) I hereby undertake that I assume for the complete responsibility for the
consequences which may arise in the disconnection of the said water
service account;
6) I am executing this Affidavit freely to attest to the truth of the foregoing
facts and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I HAVE hereunto set my hand this 16th day of August
2023 at ___________________________________.

___________________________
Affiant

SUBSCRIBED AND SWORN to before me this _______________________ at

_____________________________. Affiant exhibited her
___________________________ as competent evidence of identity.