Sample Affidavit of Undertaking - Philippine Consulate General in

I,. , ______ citizen, of legal age and presently residing at. after having been duly sworn in accordance with the law, hereby depose and state that: I...

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REPUBLIC OF THE PHILIPPINES PHILIPPINE CONSULATE GENERAL LOS ANGELES, CALIFORNIA, U.S.A.

) ) S.S. )

AFFIDAVIT OF UNDERTAKING I, ______________________________, ___________ citizen, of legal age and presently residing ADDRESS IN USA at COMPLETE ___________________________________________________________________________________

after having been duly sworn in accordance with the law, hereby depose and state that: STATE SPECIFIC AGENCY/AGENCIES I am submitting these documents from ______________________________________________

as part of the requirements in the Philippines for _____________________________________________ ___________________________________________________________, to wit:

1. ________________________________________________________________; 2. ________________________________________________________________; 3. ________________________________________________________________; 4. ________________________________________________________________; 5. ________________________________________________________________; 6. ________________________________________________________________; 7. ________________________________________________________________; 8. ________________________________________________________________; 9. ________________________________________________________________; 10. _______________________________________________________________;

Affiant further sayeth naught. MONTH

IN WITNESS WHEREOF, I have hereunto affixed my signature this ____ day of _____________ PLACE WERE YOU SIGNED THIS AFFIDAVIT 20___, in Los Angeles, California, U.S.A.

_______________________________ Printed Name and Signature of Affiant