REPUBLIC OF THE PHILIPPINES )

__________________ ) S.S.

AFFIDAVIT OF UNDERTAKING AND LETTER OF AUTHORITY

I, _______________________________________________, of legal age, Filipino

citizen, single/married, with residence and postal address at
___________________________________________________________________, after having
been duly sworn to in accordance with law, hereby depose and state:

1. That I am an employee of the Department of Energy (DOE) holding the

__________________ position of the _______________ Division, _____________
Bureau/Services;

2. That due to DOE COA Resident Auditor’s disallowance of 2010-2011 CNA

Incentives which is at present pending appeal before the Supreme Court, I am executing this
affidavit in order to formally declare my personal undertaking to pay the amount I received
amounting to Php157,560.00 in case I will be required by a final and executory decision to pay
the said amount;

3. That I hereby further voluntarily manifest that I am authorizing the DOE and all the
concerned government agencies to deduct the corresponding amount of money from any receivables
or monetary benefits that I may be entitled to from the DOE and other government agencies;

4. That I have executed this affidavit to attest to the truth of the foregoing statements
and for the proper guidance and information of the Department of Energy and for other legal
purpose this affidavit may have its worth.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ______________ at

________________.

____________________________
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, this __________________________

at _________________, affiant exhibited to me her _________________________________.

Doc. No. ________;

Page No. ________;
Book No. ________;
Series of 2021.

REPUBLIC OF THE PHILIPPINES )

__________________ ) S.S.
 AFFIDAVIT OF UNDERTAKING AND LETTER OF AUTHORITY

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

residence and postal address at _________________________________________________,
after having been duly sworn to in accordance with law, hereby depose and state:

1. That I am an employee of the Department of Energy (DOE) holding the

_______________________________ position of the _________ Division, _______________
Bureau/Services and will retire effective ______________;

2. That I voluntarily agree to return the amount I received from the DOE which is
negotiated/transacted on behalf of the DOE-Employees Association (DOE-EA), in case a final
and executory decision or order of higher authorities issued requiring the payment of the said
amount.

3. That I hereby further voluntarily manifest that I am authorizing the DOE-EA, and all
the concerned government agencies to deduct the corresponding amount of money from any
receivables or monetary benefits that I may be entitled to from the DOE and other government
agencies;

4. That I have executed this affidavit to attest to the truth of the foregoing statements
and for the proper guidance and information of the Department of Energy and for other legal
purpose this affidavit may have its worth.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ______________ at

__________________.

__________________________
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, this __________________________

at __________________, affiant exhibited to me her ________________________________.

Doc. No. ________;

Page No. ________;
Book No. ________;
Series of 2021.