UNDERTAKING FOR NURSES TO UK

I, ________________________________________, Filipino, of legal age, resident of

_________________________________________________________________ after having been duly
sworn to in accordance with law do hereby depose and state:

I am aware that Camox Philippines, Inc. (Camox) is a reputable licensed and registered agency
with the Philippine Overseas Employment Administration (POEA), that has partnerships with employers
and agencies in the United Kingdom (UK) to obtain employment for Filipino nurses.

That, I never paid any placement fees and that neither Camox nor any person acting as a recruiter
or agent of Camox asked me to pay any placement fee as part of the recruitment process for the above-
mentioned countries;

That, I voluntarily agree to process my application with Camox for employers currently accredited
with or to be accredited with in the future with Camox;

That, in the event I withdraw my application at any stage of the recruitment process, I agree to
reimburse Camox the corresponding actual and administrative costs, covered by supporting documents,
pertaining to my agreement to be processed for employment in UK, as per the “Schedule of Administrative
Charges for Withdrawing Candidate” form I signed and integrally attached to this undertaking as Annex
“A”;

That, in the event of any unforeseen or unavoidable occurrence which may result in non-
completion of the recruitment process on my part, I agree to reimburse Camox of any and all costs
advanced by Camox corresponding to the processing stage that I have already reached at the time of the
happening of the unforeseen or unavoidable occurrence;

That, I have neither been involved, charged or have committed any offense, civil or otherwise,
nor have been apprehended by police authorities or NBI in the Philippines, or equivalent authorities in
foreign countries, nor have been incarcerated, for reason I may be refused entry to start employment in
the country I will be deployed;

That, I did not provide or submit false information or documents for purposes of being deployed
for overseas employment, which is an offense and a ground for disciplinary action against Overseas
Workers per part VII Rule III of the POEA Rules and Regulations Governing the Recruitment and
Employment of Land-based overseas workers;

That, I do not have any pending case involving monetary accountabilities with my former
employers in the Philippines or any other country;

That, for any reason of untruthfulness of the foregoing statements, I will not hold Camox liable
for my repatriation, and that I shall bear the cost thereof, and will not file any complaint or claim
whatsoever as a result thereof;
 And that, I am voluntarily and willfully executing this Affidavit of Undertaking, free from duress,
threat or intimidation.

______________________________

Nurse: (signature over printed name)

Date: _________________________