Republic of the Philippines} } s.s.

AFFIDAVIT OF UNDERTAKING
I, Ma. Irene Castillo-Quijano, of legal age, Filipino, Medical Director and owner of
Our Lady of Rosary Hospital, Poblacion, Macabebe, Pampanga, after having been duly
sworn in accordance with law, do hereby depose and state that:
1. That the Bureau of Fire Protection (BFP)-Macabebe Fire Station conducted Fire Safety
Inspection at the Our Lady of Rosary Hospital on 04 November 2019 thru the authority
of Inspection Order No. RO3-610-0519-S2019 presented;

2. That the BFP-Macabebe thereafter issued Notice to Comply (NTC) Number RO3-610-
004-S2019 on the violation of Sec. 10.2.6.7.A.3 of the Revised Implementing Rules and
Regulations (RIRR) of the Fire Code of the Philippines (R.A. 9514) that is Unserviceable
Automatic Fire Suppression System (AFSS);

3. That after learning the said violation, I, Ma. Irene Castillo-Quijano, coordinated to the
BFP-Macabebe Fire Station Office on the day of the issuance of NTC;

4. That the said violation includes absence of generator set (genset) dedicated only to
AFSS-Sprinkler System. At present, the AFSS-Sprinkler System is attached to building’s
genset;

5. That in order to effect the issuance of Fire Safety Inspection Certificate (FSIC) C.Y. 2019
of Our Lady of Rosary Hospital, I herein promise to comply recommendation of
provisioning a new genset dedicated only to AFSS-Sprinkler System of Our Lady of
Rosary Hospital for the period of six (6) months from this date;

6. That I understand that under the law, the BFP-Macabebe shall not be liable for any
mishap that may happen within the period of this undertaking, directly or indirectly
related to the consequences of not provisioning a dedicated genset for the AFSS-
Sprinkler System of Our Lady of Rosary Hospital.

That this affidavit is executed to attest the truth of the foregoing facts.

IN WITNESS HEREOF, I set my hand this ____________at

___________________________________________, Philippines.

Ma.Irene Castillo-Quijano
Affiant

SUBSCRIBED AND SWORN to before me this __________________at

_____________________________________________, Philippines.

Doc No._________
Page No.________
Book No._______
Series of 2019.