REPUBLIC OF THE PHILIPPINES)

CITY OF _____________ . . . . . . .) S.S.

X - - - - - - - - - - - - - - - - - - - - - - - -/

AFFIDAVIT OF UNDERTAKING

I, NORHAYA RAUF USMAN of legal age, Filipino, married and with residence
address at Ampao, Bacolod Grande, Lanao del Sur, after having been duly sworn to in
accordance with the law, do hereby depose and state, THAT:

1. I am the LEGAL BENEFICIARY/CLAIMANT of the late Mr. ABUSAMAD

BATARA USMAN principal member of the HOME DEVELOPMENT MUTUAL FUND for the
total savings/additional death benefits;

2. I am now claiming the provident benefits proceeds due to his DEATH;

3. I have UNDERSTOOD the consequences as explained to me by the Officer and

Staff of the Home Development Mutual Fund as to the release of the provident benefits
check/s in my favor;

4. I hold Home Development Mutual Fund FREE from any liability civil or criminal
or of whatever nature that will arise from any third party claim in relation to the release of the
provident check/s in my favor;

5. I HOLD myself solely responsible for any liability civil or criminal of whatever
nature that will arise in connection with the release of provident benefit check of the late
ABUSAMAD BATARA USMAN in my favor;

6. .I am executing this affidavit to attest to the truth of the foregoing and for
whatever legal purpose or intent this may duly serve.

IN WITNESS WHEREOF, we have hereunto set our hands this ___th day of
_______________, 2019 at __________________, Philippines.

NORHAYA RAUF USMAN

Affiant

SUBSCRIBED AND SWORN to before us this ___th day of _______________, 2019

at __________________, Philippines. Affiant exhibited to me her
_______________________________, issued at _______________________ on
_______________________.

Doc. No. ____________;

Page No. ____________;
Book No. ____________;
Series of ____________.