Republic of the Philippines

Department of the Interior and Local Government

National Police Commission
NATIONAL HEADQUARTERS, PHILIPPINE NATIONAL POLICE
Camp Crame, Quezon City

AFFIDAVIT of UNDERTAKING
(Revised Form 2009)
I, _______________________________________________, of legal age, residing at
(Rank) (First Name) (Middle Name) (Last Name)
__________________________ a bonafide member of Philippine National Police,
presently

assigned at _______________________ designated to the position as

__________________
(Office/Unit)
__________________________ effective on _________________________________ after having
duly sworn to in accordance with law, do hereby depose and state:
That, I am an applicant for promotion to the rank of
__________________________;
That, my highest educational attainment in a recognized institution of higher
learning is
___________________________________________________;
(Baccalaureate/Masters/Doctorate Degree)

That, my highest promotional eligibility is

______________________________________;
(NAPOLCOM Exam/CSC Prof/PO/PD 907/RA 1080)

That, my highest mandatory training is ___________________________________

which I
(Equivalence Accredited by DHRDD)

completed on _______________________________:
That, all documents I have submitted to support my promotion are genuine
and authentic and that all the originals are now with me for verification and/or
comparison;

That, I have no pending criminal nor administrative case or any other claim
filed against me as of this date in any court, tribunal or quasi-judicial agency and
there is no complaint proffered against me before the Ombudsman or the PLEB;

That, if I should therafter learn that a criminal or administrative case has

ben filed or pending, or that a complaint was proffered against me before the
Ombudsman or the PLEB, I shall report the fact within five (5) days from
knowledge to the Promotion Board through the Secretariat the complete
statement of the present status of the case;

That, I agree to the automatic nullification of my promotion and I hold

myself liable for perjury, falsehood, misrepresentation or omission or act of
dishonesty:

a. If it would be discovered later on that a criminal or an administrative

case was filed or is pending or, that a complaint was proffered against me
before the Ombudsman or the PLEB and there was failure on my part to
immediately inform the Board of the same;
b. Or for any fraudulent, fake or tampered documents that I have
submitted;

That, I attest to the truthfulness of this undertaking and submit to the legal
and administrative consequences thereof if ever the statements above are
wanting in truth and in substance.
______________________________________
Affiant
 Community Tax Cert No.______________________________
Dated:____________ Place:___________________________

SUBSCRIBED AND SWORN TO before me this ____ day of _______________, 2009, at

____________________________, Philippines.

___________________________________
(Administering Officer)

Republic of the Philippines

Department of the Interior and Local Government
National Police Commission
NATIONAL HEADQUARTERS, PHILIPPINE NATIONAL POLICE
Camp Crame, Quezon City

AFFIDAVIT of UNDERTAKING
(Revised Form 2009)

I, _______________________________________________, of legal age, residing at

(Rank) (First Name) (Middle Name) (Last Name)
__________________________ a bonafide member of Philippine National Police,
presently

assigned at _______________________ designated to the position as

__________________
(Office/Unit)
__________________________ effective on _________________________________ after having
duly sworn to in accordance with law, do hereby depose and state:
That, I am an applicant for promotion to the rank of
__________________________;
That, my highest educational attainment in a recognized institution of higher
learning is
___________________________________________________;
(Baccalaureate/Masters/Doctorate Degree)

That, my highest promotional eligibility is

______________________________________;
(NAPOLCOM Exam/CSC Prof/PO/PD 907/RA 1080)

That, my highest mandatory training is ___________________________________

which I
(Equivalence Accredited by DHRDD)

completed on _______________________________:
That, I have pending case (s) hereunder:

CRIMINAL/ STATUS OF THE NATURE OF

Admin Case CASE CASE NR COMPLAINANT(S OFFENSE (S)
(s) (How many )
years)

That, all documents I have submitted to support my promotion are genuine

and authentic and that all the originals are now with me for verification and/or
comparison;

That, I agree to the automatic nullification of my promotion and I hold

myself liable for perjury, falsehood, misrepresentation or omission or act of
dishonesty or for any fraudulent, fake or tampered documents that I have
submitted;

That, I attest to the truthfulness of this undertaking and submit to the legal
and administrative consequences thereof if ever the statements above are
wanting in truth and in substance.
______________________________________
Affiant
Community Tax Cert No.______________________________
Dated:____________ Place:___________________________

SUBSCRIBED AND SWORN TO before me this ____ day of _______________, 2009, at

____________________________, Philippines.

___________________________________
(Administering Officer)