REPUBLIC OF THE PHILIPPINES)

Province of Maguindanao ) S.S

Municipality of Guindulungan )
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AFFIDAVIT OF UNDERTAKING
(For Patrolman/Patrolwoman)

I, DATU ALI KASIM MIDTIMBANG of legal age, Filipino, and presently residing at
BRGY. TAMBUNAN II GUINDULUNGAN MAGUINDANAO DEL SUR, after having duly
sworn to in accordance with law, do hereby depose and state that:

1. Pursuant to this affidavit, I am confirming that the Following is legal beneficiary

and/or heirs, to wit:

NAME RELATIONSHIP BIRTHDATE

BAI NUR-AYN MIDSALIPAG MIDTIMBANG WIFE 04/29/1992

KHAIRUN MIDSALIPAG MIDTIMBANG SON 05/06/2018

2. My relationship with person whose name listed above is borne out by the fact that I

am the lawful husband and father of the afore-named person;

3. I hold myself criminally and administratively liable for perjury and dishonesty

should any statements made herein are inaccurate or later found to be false and

violation of law.

AFFIANT SAYETH NAUGHT:

DATU ALI KASIM MIDTIMBANG

Affiant

SUBSCRIBED AND SWORN to before me this ___ day of ____________ 2024 at

__________________________, Philippines.

Doc No. _________

Page No. _________
Book No. _________
Series No. _________