ANNEX F: Affidavit of Undertaking

REPUBLIC OF THE PHILIPPINES)

CITY/MUNICIPALITY OF ______________________

AFFIDAVIT OF UNDERTAKING

I, ____________________________, of legal age, ____________, and a resident of

____________________________________________________, after being duly sworn to in accordance
with the law, depose and say:

1. That I am the authorized representative of___________________________ located at

_____________________________________________________________________.

2. That I undertake to submit required clearances from other agencies as stipulated under Section
302 (12) b of the IRR of the National Building Code of the Philippines, and other documents or
clearances from government authorities as maybe provided by local ordinances and/or national
laws to the Office of the Building Official (OBO) within 30 calendar days after the issuance of
Building Permit.

3. That I executed this affidavit of undertaking for and in behalf of the said establishment. Default or
failure to submit permits/clearances after 30 calendar days shall subject to the suspension of the
Building Permit and its construction. Failure to submit permits/clearances shall be dealt with in
accordance to Section 306 of the NBCP.

4. That I further executed this undertaking to attest to truth and veracity of the foregoing statements
and for all legal intents and purposes.

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

______________________.

______________________________________
Name of Applicant

SUBSCRIBED and sworn to before me this ____ day of ____________, in the City/Municipality of
______________________ by ________________________________ with
______________________________ (Proof of Identification/Identification Number), issued on
___________________________ at __________________________________.

Doc. No.________ NOTARY PUBLIC for _________________

Page No._______ Commission Serial No. ________________
Book No. _______ Until December 31, ___________
Series No. ______ Roll of Attorney _________________
IBP No.____________/_____________/______________
PTR No. ___________/____________/_______________