REPUBLIC OF THE PHILIPPINES )

TAYTAY, RIZAL)
AFFIDAVIT OF UNDERTAKING
NAME OF COMPANY
I, _________________, of legal age, Filipino, with residence and postal address at
_____________________________, after having been duly sworn to in accordance with
law, hereby depose and state:
1. That I am the POSITION of NAME OF COMPANY (the COMPANY), a corporation
duly registered with the Securities and Exchange Commission to engage in the
importation of ______________________________;

2. That I am presently applying in behalf of the above corporation for BIR

IMPORTER/CUSTOMS BROKER CLEARANCE CERTIFICATE with the Bureau of
Internal Revenue for importation purposes pursuant to Department Order
No. 12 series of 2014;
3. That I hereby undertake to comply with the duty to preserve and maintain
records of all my importations for a period of ten (10) years and to allow
access to examination by the BIR, BOC, and the Fiscal Intelligence Unit of the
Department of Finance (DOFFIU);
4. That this affidavit is executed in order to attest to the truthfulness of the
foregoing narration of facts in compliance with the requirement of the
BUREAU OF INTERNAL REVENUE and the DEPARTMENT OF FINANCE as basis
for the approval of our application for importations and for whatever legal
intents and purposes it may serve.
IN WITNESS WHEREOF, I am affixing my signature this __th day
of ______, 2014 in __________.

______________________________
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, this ________ day of

______________, 2014 in _____________ Philippines. Affiant exhibited to me his/her
__________________________.

NOTARY PUBLIC

Doc. No.___________
Book No. __________
Page No. __________
Series of __________