REPUBLIC OF THE PHILIPPINES]

PROVINCE OF BOHOL ]S.S.

CITY OF TAGBILARAN ]

AFFIDAVIT OF UNDERTAKING

I, JIM VAN ANCOG MUTIA, Filipino, of legal age, married to JUNELYN CABUSAO and
a resident of Bilar, Bohol, Philippines, after having been duly sworn to in accordance with law,
do hereby depose and say:

That I and JUNELYN CABUSAO were legally married on January 7, 2001 at Sta. Cruz
Chapel, Dao District, Tagbilaran City solemnized by Msgr. Margarito Gonzaga;

That during our union as married couple we have three (3) children, namely: Vie Jay
Mutia, 11 years old , Yvanna Mutia, 9 years old and Luis Ivan Mutia, 6 years old;

That presently, we are no longer living together as husband and wife and decided to part
ways;

That I am presently connected with HUI YEH MACHINERY COMPANY LTD. with
business address at Taiwan;

That by virtue of these presents, I hereby undertake to give and deliver in favor of my
wife, JUNELYN CABUSAO the sum of Five Thousand Pesos (5,000) per month starting June
30, 2012 and the years thereafter in support of my family ;

That further, I hereby agree and allow the above–mentioned employer and all other
employers in the future to automatically deduct the said amount from my salaries and wages;

That this Affidavit of Undertaking is executed to attest the fact of the above-stated and
for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 28 th day of May, 2012 at the
City of Tagbilaran, Bohol, Philippines.

JIM VAN ANCOG MUTIA

Affiant
PhilHealth ID 19-02644858-4

SUBSCRIBED AND SWORN to before me this 28th day of May, 2012 at the City of
Tagbilaran, Bohol, Philippines.

ATTY. FELIX REALISTA UY

Doc. No. 205 ; Notary Public
Page No. 81 ; Until December 31st 2013
Book No. XIII ; PTR No. 0899044; – 12-16-11
Series of 2012 . IBP No. 799719; – 02-13-11
TIN-118-668-273
Roll No. 31776
MCLE Compliance # III-0020132