REPUBLIC OF THE PHILIPPINES )

_____________ CITY ) S.S

AFFIDAVIT OF UNDERTAKING

I, (name) , an applicant for (position

applied for) , after having been duly sworn in accordance with
law, hereby undertake to perform the following, in connection with
my application for the position of ____________:

1. I shall inform the Council in writing and submit an updated

Comprehensive Medical Certificate should I contract the
Coronavirus Disease (COVID-19) at any stage of the
application process;

2. I will subject myself to a Real-Time Polymerase Chain Reaction

(RT-PCR) testing, and inform the Council in writing the results
thereof together with an updated Comprehensive Medical
Certificate in any of the following cases: (a) should I experience
fever, colds, cough, sore throat, shortness of breath, fatigue,
muscle and joint pains, sneezing not related to allergy, and
other COVID-19 related symptoms; (b) should I come in close
contact with a known case of COVID-19; (c) should I have a
recent local or foreign travel to a location with confirmed
COVID-19 case; and/or (d) should I, in any manner
whatsoever, contract the COVID-19 at any stage of the
application process;

3. I will inform the Council in writing together with an updated

Comprehensive Medical Certificate should I contract any
COVID-19 related disease or any other serious illnesses at any
stage of the application process.

Should I have been found to have made false statements,

misrepresentations, or concealments regarding my foregoing
undertaking, I understand that I shall be considered disqualified
from being nominated by the Council.

________________________
Affiant

SUBSCRIBED and SWORN to before me this ___ day of

__________ 2020 at __________, by Affiant who personally appeared
before me, exhibiting to me _______________________________________.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2020.