Republic of the Philippines )

Province of Negros Oriental..) S.S.

City of Dumaguete)

AFFIDAVIT OF UNDERTAKING

I, JOSEPH G. TAN, of legal age, Filipino, and a resident of Hinagaran, Negros Occidental, after
having been sworn to in accordance with law, do hereby depose and state:

1. That I am leasing a SIX HUNDRED (600) SQUARE METERS, MORE OR LESS,

portion of a parcel of land known as Lot No. 4061-A, covered by Transfer Certificate of Title No. 109-
2020000009, situated in Junob, Dumaguete City, Negros Oriental;

2. That I am applying for a Building permit on the above-mentioned Lot to the Office of the
Local Building Official and/or Engineering Office of Dumaguete City;

3. That until this date there is no approved subdivision plan and land title of the above-
mentioned lot;

4. That I am constructing a building over the above-mentioned parcel of land;

5. That I therefore hold myself responsible for whatever consequences for the possible
issuance of building permit over the above-mentioned parcel of land;

6. That the Office of the Local Building Official and/or Engineering Office of Dumaguete
City shall not be held responsible for whatever claims, conflict or problems may arise in the future
involving the issuance of Building permit over the above-mentioned parcel of land;

7. That I executed this affidavit to attest to above-stated facts for whatever legal purpose it
may deem serve and for the purpose it may deem serve;

IN WITNESS WHEREOF, I have hereunto affixed my signature this __________________ in

Dumaguete City, Negros Oriental, Philippines.

JOSEPH G. TAN
Affiant

SUBSCRIBED AND SWORN to before me this __________________ in Dumaguete City,

Negros Oriental, Philippines, personally appeared, JOSEPH G. TAN, who exhibited to me his Driver’s
License No. F01-98-121924, and he attested that he is the same person who personally signed before me
the foregoing affidavit and acknowledged that he voluntarily executed the same.

Doc No. ___;

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