Republic of the Philippines)

City of Quezon……………….)s.s.
X.........................)

AFFIDAVIT OF UNDERTAKING

I, ____________________________, after having been sworn to in accordance

with the law, do hereby depose and state:

That I intend to avail my and I submitted all the documentary requirements

needed for the processing of my Claim on (date);

That a typographical error in the spelling of my name occurred in my documents

as specified in the submitted______________-’;

That I, _____________, which appeared on my Identification Card is the same

person as_______________;

That this Affidavit of Undertaking will serve as a pre-condition for the release of
my retirement benefits and all other claims related to my retirement for the purpose of
restitution or restoration in favor of the government, in case of injury or damage;

That I agree and undertake to pay and reimburse any such third person/s who
may be prejudiced and damaged by virtue of my withdrawal;

That I am executing this affidavit in compliance with the requirements of Land

Bank for the encashment of Check No. ____ under the name of _____ (with Section
13, Rule 13 of the Revised Rules of Court, hindi to) and to attest the veracity of the
foregoing narrations and for whatever purpose this may serve.

THAT FURTHER AFFIANTS SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ___ day of -

___________ in the City of Quezon, Philippines.

Affiant

SUBSCRIBED AND SWORN to before me this ____day of July 2023 in the City
of Quezon, Philippines.