Affidavit of Undertaking

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Republic of the Philippines )

)
)

AFFIDAVIT OF UNDERTAKING
(PANUNUMPA)

I, Mr./Mrs./Miss ____Roy L. Lucero____, ____38___ years old, a resident of Barangay


Prk Azucenas Brgy. Balintawak, Escalante City, Negros Occidental (municipality/city) with
business address located at _________Escalante City_____________, after having been sworn
to in accordance with the law, do hereby depose and state:

That I engaged in selling/retailing of Firecrackers and Pyrotechnics devices since


___November 30, 2018____ with an expiration date on __January 30, 2019_ 2020.

That I am applying for the renewal of permit to sell/retail Firecrackers and Pyrotechnics
devices for CY 2021-2022.

That I was not able to renew the expired permit last 2020 due to the following reason/s:

1. Covid Virus Pandemic


2. Stay Home

That due to the above reason/s, I am executing his affidavit for the truthfulness and
submit to the legal consequences and hold myself liable for perjury or falsehood whereof
if ever the statements above are wanting in truth and in substance

AFFIANT FURTHER SAYETH NONE

SUBSCRIBED AND SWORN to before me this ____ day of _____________ at


______________________, ___________________, Philippines. I hereby certify that I
personally examined the herein affiant and fully convinced and satisfied that he/she
voluntary executed the same and understood the contents thereof.

Doc. No. ________


Page. No. _______
Book. No. ________
Series No. _______
Republic of the Philippines )
)
)

AFFIDAVIT OF UNDERTAKING
(PANUNUMPA)

I, Mr./Mrs./Miss ____Eliosa M. Andrade____, ____71___ years old, a resident of


Barangay Prk Azucenas Brgy. Balintawak, Escalante City, Negros Occidental
(municipality/city) with business address located at _________Escalante City_____________,
after having been sworn to in accordance with the law, do hereby depose and state:

That I engaged in selling/retailing of Firecrackers and Pyrotechnics devices since


___November 30, 2018____ with an expiration date on __January 30, 2019_ 2020.

That I am applying for the renewal of permit to sell/retail Firecrackers and Pyrotechnics
devices for CY 2021-2022.

That I was not able to renew the expired permit last 2020 due to the following reason/s:

1. Covid Virus Pandemic


2. Stay Home

That due to the above reason/s, I am executing his affidavit for the truthfulness and
submit to the legal consequences and hold myself liable for perjury or falsehood whereof
if ever the statements above are wanting in truth and in substance.

AFFIANT FURTHER SAYETH NONE

SUBSCRIBED AND SWORN to before me this ____ day of _____________ at


______________________, ___________________, Philippines. I hereby certify that I
personally examined the herein affiant and fully convinced and satisfied that he/she
voluntary executed the same and understood the contents thereof.

Doc. No. ________


Page. No. _______
Book. No. ________
Series No. _______
Republic of the Philippines )
)
)

AFFIDAVIT OF UNDERTAKING
(PANUNUMPA)

I, Mr./Mrs./Miss ______Arlyn Lim______, ______54______ years old, a resident of


Barangay 3M’S Street Barangay, Toboso, Negros Occidental (municipality/city) with
business address located at _________Toboso_______________________, after having been
sworn to in accordance with the law, do hereby depose and state:

That I engaged in selling/retailing of Firecrackers and Pyrotechnics devices since


___November 30, 2018____ with an expiration date on __January 30, 2019_ 2020.

That I am applying for the renewal of permit to sell/retail Firecrackers and Pyrotechnics
devices for CY 2021-2022.

That I was not able to renew the expired permit last 2020 due to the following reason/s:

1. Covid Virus Pandemic


2. Stay Home

That due to the above reason/s, I am executing his affidavit for the truthfulness and
submit to the legal consequences and hold myself liable for perjury or falsehood whereof
if ever the statements above are wanting in truth and in substance.

AFFIANT FURTHER SAYETH NONE

SUBSCRIBED AND SWORN to before me this ____ day of _____________ at


______________________, ___________________, Philippines. I hereby certify that I
personally examined the herein affiant and fully convinced and satisfied that he/she
voluntary executed the same and understood the contents thereof.

Doc. No. ________


Page. No. _______
Book. No. ________
Series No. _______

Republic of the Philippines )


)
)
AFFIDAVIT OF UNDERTAKING
(PANUNUMPA)

I, Mr./Mrs./Miss ______Robert Cramonte______, ______45______ years old, a


resident of Barangay Barangay 5, Campo Siete Bonifacio, San Carlos City, Negros
Occidental (municipality/city) with business address located at _________Campo Siete San
Carlos City , Negros Occidental______, after having been sworn to in accordance with the
law, do hereby depose and state:

That I engaged in selling/retailing of Firecrackers and Pyrotechnics devices since


___November 30, 2017____ with an expiration date on __January 30, 2018_ 2020.

That I am applying for the renewal of permit to sell/retail Firecrackers and Pyrotechnics
devices for CY 2021-2022.

That I was not able to renew the expired permit last 2020 due to the following reason/s:

1. Sickness problem
2. Covid 19 Virus

That due to the above reason/s, I am executing his affidavit for the truthfulness and
submit to the legal consequences and hold myself liable for perjury or falsehood whereof
if ever the statements above are wanting in truth and in substance.

AFFIANT FURTHER SAYETH NONE

SUBSCRIBED AND SWORN to before me this ____ day of _____________ at


______________________, ___________________, Philippines. I hereby certify that I
personally examined the herein affiant and fully convinced and satisfied that he/she
voluntary executed the same and understood the contents thereof.

Doc. No. ________


Page. No. _______
Book. No. ________
Series No. _______

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