Republic of the Philippines )

Province of Laguna ) S.S.

AFFIDAVIT OF UNDERTAKING

I, ______________________________, of legal age, Filipino citizen, married and a resident of

____________________________________, Philippines, after having been duly sworn in
accordance with the law, do hereby depose and state:

1. That I am travelling to ________ on ____________;

2. That through this affidavit I hereby undertake to be solely responsible and legally liable
in any event that may happen to me during my travel. In effect of the said affirmation
from any criminal, civil or administrative liability;

3. That I hereby declare under oath that I am solely responsible and legally liable in any
event that may happen to me during my travel or vacation outside the country and hereby
exonerate the officials and/or employees of the Department of Education from any and all
liabilities that may arise pursuant to the said travel;

4. That I likewise undertake to answer for all liabilities that may arise pursuant or in
connection with the aforesaid transactions;

5. That I am executing this affidavit to affirm the truth of the foregoing statements under
penalties of perjury, and for any legal purpose it may serve best.

IN WITNESS HEREOF, I hereunto sign my name below this ___ day of _______________ in
Santa Cruz, Laguna, Philippines.

______________________________
Affiant

SUBSCRIBED AND SWORN TO before me this ___ day of _______________ in Santa Cruz,
Laguna, Philippines, who has satisfactorily proven to me his identity through her ________
bearing the number ___________, that she is the same person who is personally signed before
me the foregoing Affidavit of Undertaking and acknowledged that she executed the same.

Doc. No.
Page No.
Book No.
Series of 2023