Republic of the Philippines………..

)
In the City of _______________)
x-----------------------x

AFFIDAVIT OF UNDERTAKING

I , ____________________________________________ , Filipino , _____ years

of age, single/married, and a resident of ______________________________________ ,
after having been duly sworn to in accordance with the law, hereby depose and say
THAT:

1. I am fully aware that the use of illegal drugs has no beneficial effect whatsoever
to the well-being of any person;
2. I am also fully aware that any involvement in illegal drugs undermines the efforts
of the government to eradicate the drug menace that is destroying our nation;
3. I now therefore voluntarily submit myself to the government authorities for
proper documentation for the purpose of clearing myself from any involvement in
illegal drugs, or if involved, to undergo appropriate intervention or drug
rehabilitation, as the case may be;
4. I sincerely thank the government for giving me the opportunity to clear myself
from any involvement in illegal drugs, or undergo said intervention or
rehabilitation, with the end view of having a new, peaceful and drug-free life;
5. In return, I shall give my full cooperation with and help the government in its
noble campaign against the use of or involvement in illegal drugs;
6. I am executing this affidavit on my own free will and volition, and I fully
understand the contents of the same, having been translated to me in the
vernacular or dialect which I speak or I am conversant in.

IN WITNESS WHEREOF, I have hereunto set my hand this ___________ day of

____________, 20___ , at __________________________________ , Philippines.

Assisted by:
_______________________ ________________________
Roll of Attorneys No. ______ Affiant
________________________
Gov’t Issued I.D. / Barangay Cert. of Identity
Witnesses:

______________________________ and ______________________________

SUBSCRIBED AND SWORN to before me this _____ day of ______________ ,

20___ , in __________________, Philippines, affiant exhibiting to me his/her
competent evidence of identity/Barangay Certificate of Identity as indicated above,
bearing his/her photograph and signature.

______________________________