ANNEX ____

REPUBLIC OF THE PHILIPPINES ____________________________ ____________________________

AFFIDAVIT OF UNDERTAKING

I, ________________________________ of legal age, married/single and a resident of _____________________________________________________ after having been duly sworn on oath in accordance with law, do hereby depose and say:

1) That I am an employee of the ______________________________ having been appointed/designated as Clerk of Court/Officer-in-Charge; 2) That I am in-charge in the handling of court collections and remittances thereof; 3) That I am securing a Supreme Court Clearance for travel abroad purposes/study leave application; 4) That I promise to comply with the requirements of the Fiscal Monitoring Division, CMO regarding the Audit of my financial transactions as accountable officer immediately after my return; 5) That in case of failure to comply with the requirements, I am giving authority to the Chief of the Financial Management Office to withhold my salaries and other allowances effective ________________. IN TRUTH WHEREOF, I have hereunto sign my name below this ______ day of ________________ at ________________.

________________ Affiant SUBSCRIBED AND SWORN TO before me this ____________ day of ________________ 20____ affiant exhibiting to me his/her CTC # ____________________ issued at ________________ on _________________.