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fisfl 0PRM FORM 3fi1S-1A

Republic af the Fhrlippines
Nalronal Police Commissran
NATIONAL I-IEAf]GUARTEfi S. FH I LIPPIN T NA,TIONAL POL IC E
Camp Crarne, Quezon Crty

ATF}DAVIT OT UNDTRTAKINS
IFOLTCE OFFTCER r PSF QUOTA APPLTCANTI

t of iegal ase.
ii:1.s1 flame I il,liddl€ i{ane I (La:i f'lanaii Qraljfrer,

Filrpino pr*$efitly residing at

ar"rd
havlr$ *"dy s***r tc in a*qorda$ce with l*#, ds here&y dep**a e*d stfite;

1. That I am a Folice Officer 1 {PO1} applicant for this CY ._-- Rquiar

Recruitment Program of ,., - .. - ;

{uniuofllce}

2 That lwas born on

3. Thet leffi * grsdirets *f ,., *" . ,." *,, " , . ._-pd h6}d# #f
{S€gro*r$d.s6e}
eligibrirty.

4" Thai I have not besn diehm*rabiy diaeh*rg*d fr*rn rxilit*ry sfll$l*$l1*nt or ofi
,Abuen*a With*ut *ffrclal Leave or Droppd frsrn Ralk fr*nr the PfdP p*lvica ar
dismissed for catrse from any civilian position in the Governffleni;

$. Th*t *h*ve n* Wfiding criminal *ass i* 6$y eourl i*cluding at the ffice of
the OmbudsffHn or adtninistrative case:

6. That I h*ve not heen nonuictrd b,y final iudgrnent of an ofiense or crime
involving moral turpitude;

7.That I *gfe€ ts ths *Htoffiic nulliftc*tim sf my *pp*intr*eslt &* Pslifis

Otri**r f *nd h*!d mys*$ lisble for pequry, falsehoed, rnisrepresentation or ornission of
facts, if thsr* exists a p*nding c€$s a*ein*t me and/or falsification or a*t of disho*esty
for **y traudulent, fake *r ta*Bered documer*s tix*t I tmv* submitf*d;

S" Thet I will n*i resign fmrn th* esrvifie u,ithin three {3} years after fraving taken
my c*th of a$i*e **r *eek rexs*ignr***t/detail with ofher FNF lj.Ilts or sllied ssvi*es
outsrde ef for at least flve {5} y€ar$
{{nir]

9" Thst t furth*r *srtiry ftqt th€ f*r*gor*g dff{arstisn$ are tfl& and **cr*mt* t*
the best of my knoMedge and ability and I hereby ar.rthorized the PNP to obtain and
$e*Jre p*ftirBnt ree*rd$ tha{ will $how rny qualification standards, collstorai
requrrernents and case records and other record relatad to thess dedaration rf any, in
any agpncy or office.

FURM{ER AFFIANT SAYETH NOHE:

{AfiEnta $l{r**rse 6Ysr P{ir*s* t*q,r!e}

SUBSCRIBED AHD SWORN to before me this day of , 2015

6i Philippirm, #ra*t *xhibiting hi**?er OT0 f'l*
**M at 0n

NOTARY PUBLIC