REPUBLIC OF THE PHILIPPINES)

CITY OF ) Ss.

AFFIDAVIT OF UNDERTAKING

I, __MARIA APRIL ANGELICA M. HUIZO__ of legal age, __30__ and a resident of __#3 JOSE GIL
ST. BRGY. TIBAGAN SAN JUAN CITY____, on oath depose and say; THAT:

1. I am the authorized representative of SEAHOUSE FISHERY AQUATIC RESOURCES INC. with office
address at U2204 ATLANTA CENTER CONDOMINIUM, 31 ANNAPOLIST STREET, GREENHILLS SAN
JUAN who is the manning agency of SEAHOUSE FISHERY AQUATIC RESOURCES INC. with office
address AT U2204 ATLANTA CENTER CONDOMINIUM, 31 ANNAPOLIST STREET, GREENHILLS SAN
JUAN.

2. I am the personnel in charge of receiving the following seafarers/Overseas Filipino Workers:

A.

With Flight No. _______ From ____________.

3. I undertake to bring the abovenamed person/s to the Designated Quarantine Facility to observe
the mandatory quarantine requirement of the Department of Health.

4. In case of failure of the aforementioned person/s to be brought to the Designated Quarantine

Facility, I and my manning agency shall be liable criminally and civilly under existing criminal and
civil laws of the Philippines in addition to the provisions of Section 9 (b), (d) and (e) of RA 11332,
“The Mandatory Reporting of Notifiable Diseases and Health Events of Public Concern Act”.

IN WITNESS WHEREOF, I hereby affixed my signature this ______ day of ____________,

2020 in the City of San Juan.

:SIGNATURE :NAME OF VEHICLE

:NAME OF REPRESENTATIVE :PLATE #
:CONTACT # :DRIVER’S NAME
:CONTACT #

Affiant
CDI No. _________
Issued at ________
Issued on _______

SUBSCRIBED AND SWORN TO BEFORE ME this _________ day of __________, 2020 in

the city of ____________.
REPUBLIC OF THE PHILIPPINES)

CITY OF ) Ss.

AFFIDAVIT OF UNDERTAKING

I, __MARIA APRIL ANGELICA M. HUIZO__ of legal age, __30__ and a resident of __#3
JOSE GIL ST. BRGY. TIBAGAN SAN JUAN CITY____, on oath depose and say; THAT:

5. I am the authorized representative of SEAHOUSE FISHERY AQUATIC RESOURCES INC. with office
address at U2204 ATLANTA CENTER CONDOMINIUM, 31 ANNAPOLIST STREET, GREENHILLS SAN
JUAN who is the manning agency of SEAHOUSE FISHERY AQUATIC RESOURCES INC. with office
address AT U2204 ATLANTA CENTER CONDOMINIUM, 31 ANNAPOLIST STREET, GREENHILLS SAN
JUAN.

6. I am the personnel in charge of receiving the following seafarers/Overseas Filipino Workers:

A. JOLAN F. IGNACIO

With Flight No. __C2305____ From _____INCHEON KOREA______.

7. I undertake to bring the abovenamed person/s to the Designated Quarantine Facility to observe
the mandatory quarantine requirement of the Department of Health.

8. In case of failure of the aforementioned person/s to be brought to the Designated Quarantine

Facility, I and my manning agency shall be liable criminally and civilly under existing criminal and
civil laws of the Philippines in addition to the provisions of Section 9 (b), (d) and (e) of RA 11332,
“The Mandatory Reporting of Notifiable Diseases and Health Events of Public Concern Act”.

IN WITNESS WHEREOF, I hereby affixed my signature this ______ day of ____________,

2020 in the City of San Juan.

:SIGNATURE :NAME OF VEHICLE CHEVROLET SPARK

:NAME OF REPRESENTATIVE :PLATE # WOR 592
:CONTACT # :DRIVER’S NAME EDGAR M. HUIZO
:CONTACT # 09208672542

Affiant
CDI No. _________
Issued at ________
Issued on _______

SUBSCRIBED AND SWORN TO BEFORE ME this _________ day of __________, 2020 in

the city of ____________.