REPUBLIC OF THE PHILIPPINES }

Tagum City, Davao del Norte} s.s.

AFFIDAVIT OF UNDERTAKING

I, ____________________, Filipino, single/married, a registered and licensed ______________

(profession), with address at ________________________________________ after having duly sworn
in accordance with law hereby depose and state that:

1. I am employed in Tagum Global Medical Center as a _________(position/designation) starting

_________(date of employment);
2. I applied for the position of ________________ (position);
3. I acknowledge that in order to be appointed as ______________ (new appointment), I am
required to earn ___ units of ________ (course/subjects) in compliance to __________________
(specific policy);
4. I undertake to comply with the required number of units within __________ (time period);
5. I will submit proof of my compliance with ___ total number of units within_______time period);
6. I understand that in the event I fail to submit compliance with the required total number of units,
I will not be appointed as _____________(new appointment);
7. I am executing this affidavit to attest to the truth and veracity of the foregoing statements for
whatever legal purpose it may serve.

IN WITNESS WHEREOF, the parties have signed this Agreement on the _______ day of _____________,
20__ in Tagum City, Davao del Norte.

_______________________________
Affiant

SUBSCRIBED AND SWORN to before me, a Notary Public for and in the above jurisdiction
this _____ day of ____________ personally appeared at ___________________, Philippines affiant
exhibiting to me his/her _________________________(valid issued government Identification Card)
issues on __________ at _________________.

NOTARY PUBLIC
Doc. No. _______;
Page No. _______;
Book No. _______;
Series of 2023