AFF-UND

REPUBLIC OF THE PHILIPPINES

CITY/MUNICIPALITY OF ) S.S.

AFFIDAVIT OF UNDERTAKING

I, __________________________ ___ _, of legal age, ______ and a

resident of ___________________________________________ ______ after having been duly
sworn to in accordance with the law, depose and say:

1. That I am the authorized representative of ___________________ __ located

at _______________________________________________________________________.

2. That I undertake to submit required clearances from other agencies as stipulated under
Section 302 (12) b of the IRR of the National Building Code of the Philippines, and other
documents or clearances from government authorities as maybe provided by local
ordinances and/or national laws to the Office of the Building Official (OBO) within 30
calendar days after the issuance of Building Permit, clearances such as;
 DPWH Clearance (if along a national road)
 DepEd Clearance (for educational institution/schools)
 CAAP (ATO) Height Clearance (for cell sites, towers, spires & antennas)
 ERB Clearance (for gas stations)
 DENR ECC Clearance or Certificate of Non Coverage (CNC) (for gas station & large
scale development)
 DOH Clearance (for hospitals, telecom tower/cell site projects)
 Barangay Clearance
 Other

3. That I executed this affidavit of undertaking for and in behalf of the said establishment.
Default or failure to submit permits/clearances after 30 calendar days shall subject to the
suspension of the Building Permit and its construction. Failure to submit permits/clearances
shall be dealt with in accordance to Section 306 of the NBCP.

4. That I informed the Neighbors (Left Side, Right Side & Rear Side) of the said property of the
proposed construction.

5. That I further executed this undertaking to attest to truth and veracity of the foregoing
statements and for all legal intents and purposes.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ___________day of

__________ , 20 .

_________________________________
Name of Applicant

SUBSCRIBED and sworn to before me, this _ __ day of ____ __________, in the
City/Municipality of ________________ by ________________________________ with
_____________________________ (Proof of Identification/Identification Number), issued on
______________________ at _______________________.

Doc. No. _______; NOTARY PUBLIC for _________________

Page No. _______; Commission Serial No. ________________
Book No. _______; Until December 31, ________
Series of _______; Roll of Attorney ____________
IBP No. _________/_________/____________________
PTR No. _________/_________/____________________