Republic of the Philippines )

City of ________________) S.S.

AFFIDAVIT OF UNDERTAKING
(FOR 10-YEAR VALIDITY PERIOD OF LTOPF)

I, ___________________________, of legal age, single/married, Filipino, and a

resident of _____________________________________, after having been sworn in
accordance with law, do hereby depose and say, THAT:

1. I am an applicant for License to Own and Possess Firearms (LTOPF) and

opted to avail ten years validity period of my LTOPF;

2. Having opted to have a 10-year LTOPF validity period, I shall undertake to

submit Neuro-Psychiatric Clearance and Drug Test Result when required by
the CPNP or his authorized representative as part of monitoring my fitness to
own and possess firearm;

3. In case there is failure or refusal on my part to submit my Neuro-Psychiatric

Clearance and Drug Test Result, when required, my LTOPF and that of the
firearm registration shall be suspended immediately without prior notice and
the firearm/s shall be confiscated; and

4. I am executing this affidavit to attest to the truthfulness of the foregoing and

for all legal intents and purposes.

IN WITNESS WHEREOF, I hereunto affix my signature this ______ day of

_________ 2022 at ________________________.

___________________
AFFIANT

SUBSCRIBED AND SWORN TO before me this ______ day of

_______________, 2022 at ________________________________________, affiant
having exhibited to me his/her ID Card Number _________________ issued on
_________________ and with Expiration Date of ____________________________.

Notary Public

Doc. No.:_______
Page No.:_______
Book No.:_______
Series of 20____