Republic of the Philippines)

(S.S.

AFFIDAVIT OF UNDERTAKING

I, __________________________________________________, of legal age, with office address at

__________________________________________________________________, after being sworn in accordance
with law, do hereby deposes and states that:

1. I am the consignee/duly authorized representative/Licensed Customs Broker of:

_______________________________________________ in behalf of Consignee
___________________________________;
2. On __________________________, the shipment of
__________________________________________________________________ covered by Airway Bill No.
______________________________ arrived in the Port of NAIA, which are intended for
commercial to the government institutions and/or accredited private entities for
distribution to or use of victims if Corona Virus Pandemic commercial, arrived in the
Port of NAIA;
3. I behalf of the consignee, I, under the pain of criminal, civil, and administrative
prosecution of pertinent customs and allied laws, rules and regulations, hereby
affirms, verifies and/or undertakes that:
a. the subject shipment are indeed intended for commercial to the
government institutions and/or accredited private entities for distributions
to or use of victims of Corona Virus Pandemic;
b. to obtain and submit to the Port of NAIA all lacking documents;
c. the use and distribution of the subject shipment shall only be undertaken
upon issuance of the required clearances from respective regulating agency;
d. that the consignee is willing to pay the Port of NAIA – Bureau of Customs,
the customs duties, and taxes, including other fees and charges due the
above-identified goods;
e. that the consignee is not availing the Tax Exempt Indorsement from the
Department of Finance; and
f. Strict compliance with all pertinent customs and allied laws, rules and
regulations prior to tentative release of the above-identified shipment under
Provisional Goods Declaration pursuant to the Memorandum dated 18
March 2020 of Commissioner Rey Leonardo B. Guerrero and Customs
Memorandum Order No. 02-2020 Republic Act 11469, otherwise known
as “Bayanihan to Heal as One Act”
4. Affiant further sayeth naught;

IN WITNESS WHEREOF. I have set my hand this _____th day of ___________________ 2020 at
_____________________________.

_________________________________________________________
Affiant

SUBSCRIBED AND SWORN to before me this ____________________________________ at

_________________________, affiant exhibit to me _____________________________________.

Doc No. ______________________;

Page No. _____________________;
Book No. _____________________;
Series of 2020.