Republic of the Philippines )

) S.S.

AFFIDAVIT OF UNDERTAKING
I, Filipino citizen of legal age, single, and a resident
of Philippines and also a Filipino
citizen, of legal age, married and a resident of Philippines
after having been sworn to in accordance with law, do hereby and state that:

1. is a student at the University of Cebu Maritime

Education and Training Center ( UCMETC );

2. I hereby promise and undertake to submit the PEME certificate and laboratory results
as soon as possible to UCMETC Medical Clinic;
3. If I fail to submit the PEME certificate and laboratory results within this semester, I
understand that I have not complied with the Joint CHED-Marina Memorandum Circular
(JCMMC) No. 3 Series of 2019 and STCW 2010 Manila Amendment 2017 Edition
Requirement on the medical standards for Administration/Retention of Maritime
Students and I will explain to the Dean of Maritime Studies why I should still be retained
as a maritime student;
4. I understand also that I will be considered block listed by the registrar for non-
compliance ;
5. If and when the PEME certificate states that I am not fit for sea service then I will not
enroll during the next semester but I will just finish this semester;
6. I am executing this affidavit in order to attest the truth and veracity of the forgoing
statements and for whatever legal purpose may serve best;

IN WITNESS WHEREOF, I have hereunto voluntarily affixed my signature on

2024, in Cebu City, Cebu Philippines
.

______________________________________
(Student) (Parent or Guardian)

Affiant Affiant
Contact Number: Contact Number:
Student ID No.:

SUBSCRIBED AND SWORN TO before me on 2024, in Cebu City, Cebu, Philippines, above
affiants having presented to me their valid IDs as indicated above as competent proofs of their
respective identities.