REPUBLIC OF THE PHILIPPINES )

CITY OF MANILA ) S.S.

AFFIDAVIT OF UNDERTAKING AND LETTER OF AUTHORITY

I, ___________________________, of legal age, Filipino citizen, single/married, with

residence and postal address at Karangalan, Manggahan, Pasig City, after having been duly
sworn to in accordance with law, hereby depose and state:

1. That I am an employee of the Department of Energy (DOE) holding the position of

______________________________ at the _________________________________ and
consequently due to retire effective 01 February 2023;

2. That due to DOE COA Resident Auditor’s disallowance of 2010-2011 CNA

Incentives which is at present pending appeal before the Supreme Court, I am executing this
affidavit in order to formally declare my personal undertaking to pay the amount I received
amounting to Php157,560.00 in case I will be required by a final and executor decision to pay or
refund the said amount;

3. That I hereby further voluntarily manifest that I am authorizing the DOE and all the
concerned government agencies to deduct the corresponding amount of money from any receivables
or monetary benefits that I may be entitled to from the DOE and other government agencies;

4. That I have executed this affidavit to attest to the truth of the foregoing statements
and for the proper guidance and information of the Department of Energy and for other legal
purpose this affidavit may have its worth.

IN WITNESS WHEREOF, I have hereunto set my hand this

__________________________ at the City of Manila.

_____________________
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, this ______________________ at

the City of Manila, affiant exhibited to me his/her Taxpayer Identification No.
_____________________.

Doc. No. ________;

Page No. ________;
Book No. ________;
Series of 2024.