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Republic of the Philippines

City/Mun. of __________) S.S.


xx

AFFIDAVIT OF UNDERTAKING

I, TIFFANY KATE ANGEL VILLARMINO, of legal age, Filipino, single and a


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

1. That I was employed as (position) in the Research Institute of Tropical Medicine


and resigned on ______________________________.

2. That I have applied for Terminal Leave effective _______________________.

3. That I hereby authorize the Institute to deduct all of my financial obligations from the
money value of my terminal leave;

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

IN WITNESS HEREOF, I have hereunto signed my name below this ____ day of
________________, 2017 at ______________________, Philippines.

TIFFANY KATE ANGEL VILLARMINO


Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this _______ day of _________


___________, 2017, affiant exhibited to me his Government Issued ID __________with
No._________________ issued at ____________________ on ____________________.

Doc. No. ________


Page No. ________
Book No. ________
Series of ________ NOTARY PUBLIC

Republic of the Philippines


City/Mun. of __________) S.S.
xx

AFFIDAVIT

I, TIFFANY KATE ANGEL VILLARMINO, of legal age, single, Filipino citizen, and
presently residing at _____________________, after having been duly sworn to in accordance
with law, do hereby depose and say:

1. That I was formerly employed as ____________________________ in the Research


Institute of Tropical Medicine;

2. That I resigned effective __________________.

3. That there is no administrative criminal investigation or prosecution against me for


any offense, defined or penalized under RA3019, otherwise known as the Anti- Graft
and Corrupt Practices Act, as amended and under the provisions of the Revised Penal
Code; and

4. That I am executing this affidavit to attest to the truth of the foregoing facts or
assertation in compliance with COA Memorandum No. 451 dated March 6, 1973.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed my signature this ____ day
of _______ 2017 at ______________, Philippines.

TIFFANY KATE ANGEL


VILLARMINO Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this _______ day of _________


___________, 2017, affiant exhibited to me his Government Issued ID __________with
No._________________ issued at ____________________ on ____________________.

Doc. No. ________


Page No. ________
Book No. ________
Series of ________ NOTARY PUBLIC