Affidavit of Undertaking Retirement

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Republic of the Philippines

______________________

AFFIDAVIT OF UNDERTAKING
(Retirement)

I, _______________________, of legal age, Filipino, single/married/widow/widower and a


resident of ________________________________________________, after having been duly
sworn to in accordance with law, hereby voluntarily depose and say:

1. That I will retire/retired on _____________________________;

2. That I have applied for Retirement Benefits effective _________________________;

3. That my terminal leave benefits is not sufficient/have no terminal leave benefits to


cover my COA bill from the Commission amounting to _________________ and loan
obligations from the ________________________________________ amounting to
(Financial Institutions)
__________________;

4. That I will pay my obligations to the ______________________________


immediately after receipt of my GSIS Retirement Benefits; and

5. That I am executing this affidavit to attest to all the above facts.

IN WITNESS HEREOF, I have hereunto signed my name below this ________ day of
_____________,20 ______ at ________________.

___________________
(Affiant)

SUBSCRIBED AND SWORN TO BEFORE ME this _______ day of _________


___________,20 ______, affiant exhibited to me his/her Government issued ID _________ No.
______________ issued at __________ on ________________.

Doc. No. ________


Page No. ________
Book No. ________
Series of ________

NOTARY PUBLIC

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