REPUBLIC OF THE PHILIPPINES )

PROVINCE OF ___________ ) S.S.

MUNICIPALITY OF ______ )

AFFIDAVIT OF UNDERTAKING
I, ______, of legal age, single, Filipino and presently residing at _______,
after having been duly sworn to in accordance with law, deposes and says
THAT:

I am presently appointed as Public Attorney II at Public Attorney’s Office,

District Office of _______ with a temporary status subject to renewal every after
one (1) year from the date of my last appointment.

My previous appointment is about to expire and one of the requirements

for the renewal of my appointment is to undergo Neuro Psychiatric Examination
before the National Center for Mental Health located at Mandaluyong City.

Although I have secured clearances from government offices/agencies

and favorable recommendation for renewal of appointment from our District
Public Attorney, I have yet to comply with the requirement of Neuro Psychiatric
Examination. The Public Attorney’s Office, Regional Office has already
arranged with the National Center for Mental Health in Mandaluyong City,
Metro Manila and was given the earliest available schedule for neuro
psychiatric examination on _______ at 7:00 o’clock in the morning.

Therefore, through this Affidavit, I hereby undertake and promise to

undergo neuro psychiatric examination on the date and time above-mentioned
in order to complete the requirements necessary for the renewal of my
appointment as Public Attorney II.

I am executing this affidavit to attest to the truthfulness of the foregoing

facts and for all legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 20th day

of August 2018 in __________, Philippines.

_________________________
Affiant

SUBSCRIBED AND SWORN to before me this 20th day of August 2018 in

________, Philippines.