REPUBLIC OF THE PHILIPPINES )

________ CITY )S.S.

x-----------------------------------------------x

AFFIDAVIT OF UNDERTAKING

I, FULL NAME, Filipino, AGE years old, single and a resident of

ADDRESS, after having been duly sworn to in accordance with law hereby depose
and say:

1. That I am currently on REASON/S;

2. That I am required to submit, as a requirement, WHAT TO SUBMIT OR

SUBJECT OF UNDERTAKING;

3. That due to time constraints, REASON/S;

4. That I undertake to comply and submit it once the document is within

my control and possession.

IN WITNESS WHEREOF, I affix my signature this ___th day of October

2023 at ____________, _______ City.

FULL NAME
Affiant

SUBSCRIBED AND SWORN TO before me this ____ day of October 2023 in

__________ City, Philippines, affiant exhibiting to me his KIND OF ID issued by the
ISSUING AGENCY – PLACE OF ISSUANCE City with License No. NUMBER and
expiration date of _______________, bearing his photograph and signature.