AFFIDAVIT OF UNDERTAKING

I _________________________, of legal age, single/married, Filipino citizen with

business located at _________________________________________________ under oath,
hereby depose and state THAT;

1. I am the owner/manager/ legal representative of (name of establishment)

___________________________________________,with principal address at
__________________________________________________________________________;
2. In connection with my application for Mayor’s Permit, I do hereby UNDERTAKE
to:

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

3. Failing which I understand and admit that my eligibility and application

including permit obtained hereto stands to be automatically cancelled at the
option of the City Government of Antipolo and the latter is not to be held
responsible for the same.
4. I am executing this statement to attest to the truth of the foregoing and for
whatever lawful purpose this may serve.

IN WITNESS WHEREOF, I hereby set our hands this _____ of day _____ in
________________________

_______________________________________
PRINT NAME AND SIGN/DESIGNATION

SUBSCRIBED AND SWORN to before me, this ______ of day _______ in

______________.

NOTARY PUBLIC

Doc. No. :______

Page No. :______
Book No.:______
Series of 202__.