REPUBLIC OF THE PHILIPPINES )

PROVINCE OF ZAMBOANGA SIBUGAY) S.S

JOINT AFFIDAVIT OF COMMITMENT

We, Janice Q. Pedroso, of legal age, Filipino, a resident of Solar, Olutanga,

Zamboanga Sibugay, and the Managing Head of Olutanga Municipal Hospital located at
Bateria, Olutanga, Zamboanga Sibugay; and, Margelyn C. Palaran, of legal age,
Filipino, a resident of Villacorte, Olutanga, Zamboanga Sibugay, and the
appointed/designated Pollution Control Officer (PCO) of Olutanga Municipal Hospital,
after being sworn to in accordance with law, do hereby depose and say that:

1. We commit to ensure compliance with the requirements of Presidential Decree 1586,

Republic Act (RA) 6969, RA 8749, RA 9003, RA 9275, their respective
implementing rules and regulations, and other pertinent rules and regulations; and

2. We are executing this affidavit to attest to the foregoing statements, and to comply
with the DENR requirements for PCO accreditation pursuant to DAO 2014-02.

Done this ___day of ______________ in ___________.

JANICE Q. PEDROSO, M.D., MPH MARGELYN C. PALARAN

Affiant Affiant

SUBSCRIBED AND SWORN to before me this ____day of _____________ in

_______________, affiants personally appeared before me exhibiting their Community Tax
Certificates.

Name CTC No. Issued on/at

Notary Public
Doc. No. ______
Page No. ______
Book No. ______
Series of _______