Republic of the Philippines)

City of ________________) S.S.

AFFIDAVIT OF UNDERTAKING

I, ___________________, of legal age, (single / married / widow), and a resident of

________________________, Philippines, after being sworn to in accordance with law, depose and state:
1. That I am an employee of __________________________ having been appointed/designated
as ___________________________ and the duly authorized representative of said company
according to its Articles of Incorporation and By-Laws;
2. That I expressly undertake to completely and fully accomplish the regularization of the following
individuals (see attached list) as bonafide employees of ______________________ in
accordance with existing labor laws, rules and regulations;
3. That I further expressly undertake to complete said regularization of employees in the following
schedule/ terms, thus:
Number of Employees Effectivity date of regularization
Today, ____ of ________, 2016
_____ of ________, 2016
_____ of ________, 2016

4. That should I fail to comply with the above-mentioned undertakings, the DOLE Regional Office
No. III or its duly authorized representatives, shall immediately proceed with the issuance of a
Compliance Order and perform other appropriate measures to enforce labor laws, rules and
regulations, as outlined in the Rules of Labor Laws Compliance System, as amended;
5. That this Affidavit is executed in order to attest to the truthfulness of the foregoing and for
whatever legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this _____________ at _____________

Philippines.

______________________________
(Signature over printed name)

SIGNED IN THE PRESENCE OF:

__________________ __________________

ACKNOWLEDGMENT

BEFORE ME, a Notary Public for and in the _______________ of _____________, personally appeared _____________ with
government-issued ID No. _____________ issued on _____________ at _____________, personally known to me (or whom I have identified
through competent evidence of identity) and who represented to me that he/she is the _______________ of ___________________ and that he/she
has the authority to sign for and in behalf of the said corporation in that capacity, that his/her signature on the foregoing instrument was voluntarily
affixed by him/her for the purposes stated in the instrument and who declared that the foregoing instrument is the free and voluntary act and deed of the
said corporation.

WITNESS MY HAND AND SEAL this _____________ at _____________, Philippines.

NOTARY PUBLIC

Doc. No. ______;

Page No. ______;
Book No.______;
Series of 20____.