REPUBLIC OF PHILIPPINES )

CITY OF DAVAO ) S.S.

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AFFIDAVIT OF UNDERTAKING

I, ______________________, of legal age, and a resident of Davao City,

Philippines, after being duly sworn to in accordance with law, hereby depose and say:

1. That I am the mother of the deceased

______________________ who died on November 4, 2023;

2. That a CERTIFCATE OF DEATH was issued by the Office Of

The Civil Registrar General, on November 7, 2023, as attached in
this Affidavit (Annex A);

3. That in the metioned Certificate the deceased will be buried at

Wireless Public Cemetery, Davao City;

4. That there was a change of mind on the part of the immediate

family of the deceased to bury her remains at Maa Public
Cemetery, Davao City instead;

5. That I am executing this Affidavit to attest to the truth of the

foregoing facts and to use the same for whatever legal purpose it
may serve;

WHEREFORE, in order to attest to the truth of the foregoing, I am hereby

affixing my signature to this Affidavit of Undertaking this ______ day of _________,
2023 in Davao City.

______________________
Affiant

SUBSCRIBED AND SWORN TO before me this ____ day of ______, 2023 at

__________, affiant having executed to me his
______________________________________.