AFFIDAVIT OF UNDERTAKING Sample

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Republic of the Philippines)

​(S.S.

AFFIDAVIT OF UNDERTAKING

​I, MICHAEL HERNANDEZ​, with address at #1348 Angono St, Barangay Poblacion,
Makati City. PHILIPPINES, after being sworn in accordance with law, do hereby
deposes and states that:

1. I am the consignee / duly authorized representative / Customs Broker of: MARIA


LOVELIN TACTACAN;

2. On APRIL 3, 2020, the shipment of JINGNING HAIYUAN IMPORT AND EXPORT


CO., LTD covered by Airway Bill No. 860-01119930 arrived in the Port of NAIA, which
are intended for donation to the government institutions and/or accredited private
entities for free distribution to or use of victims of Corona Virus Pandemic;

3. I, under the pain of criminal, civil, and administrative prosecution of pertinent customs
and allied laws, rules and regulations, hereby affirms, verifies and/or undertakes that:

a. the subject shipment are indeed intended donation to the government


institutions and/or accredited private entities for free distributions to or use of victims of
Corona Virus Pandemic;

b. to obtain and submit to the Port of Naia all lacking documents, including but
not limited to Tax Exemption Indorsement (TEI) from the Department of Finance within
forty-five (45) days from date of release;

c. to obtain and submit required clearances from the regulating agency if any,
within forty-five (45)days from date of release;

d. the use and distribution of the subject shipment shall only be undertaken upon
issuance of the required clearances from respective regulating agency if any;

e. to pay the Port of Naia – Bureau of Customs, the customs duties, and taxes,
including other fees and charges , supposedly due to the above-identified goods, in
case I failed to submit the required TEI from the Department of Finance; and
f. strict compliance with all pertinent customs and allied laws, rules and
regulations.

4. Affiant further sayeth naught;

IN WITNESS WHEREOF. I have set my hand this _____th day of


___________________ 2020 at _____________________________.

MICHAEL HERNANDEZ
FOR SEC. SILVESTRE BELLO III
Affiant

SUBSCRIBED AND SWORN to before me this


____________________________________ at _________________________, affiant
exhibit to me _____________________________________ .

Doc No. ______________________;


Page No. _____________________;
Book No. _____________________;
Series of 2020.

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