Republic of the Philippines

Makati City

AFFIDAVIT OF UNDERTAKING

I, _________________________________________________________________, of legal age, Filipino,

and residing at ________________________________________________________________________________,
after having been duly sworn to in accordance with law, do hereby depose and state that:

1) I intend to apply for a salary loan with Etiqa Life and General Assurance Philippines, Inc. (“Etiqa”) in the
amount stated in my loan application;

2) I admit, warrant and represent to Etiqa that all papers, pay slips, documents and effects required for the
approval of my salary loan application are genuine and authentic in all respects and that they were duly
executed, delivered and issued by the proper government offices;

3) I have not applied nor received a loan from any financial services institution prior, particularly the
Government Service Insurance System (GSIS), prior to my application of loan with Etiqa, except for
those deductions in my latest pay slip that I submitted to Etiqa;

4) Except when my monthly net pay is sufficient to cover my monthly salary loan amortization with Etiqa, I
guarantee and undertake not to avail of any other loan application from any financial services institution
during the effectivity of my salary loan application with Etiqa;

5) I shall promptly pay the monthly loan amortizations through authorized banks and/or directly with
Etiqa in cases where my net take home pa is insufficient to cover the agreed monthly amortizations;

6) As a condition for the approval of my salary loan, I voluntarily and conscientiously agree, undertake,
obliged and commit myself, under pain of perjury and other criminal persecution, to dutifully comply with
the foregoing in good faith and all existing policies, rules and regulations and those which may
subsequently authorized by Etiqa in connection with and arising from my salary loan application.

IN WITNESS HEREOF, I hereby affix my signature with my respective identification cards on the date herein
below provided.

Makati City, Metro Manila

_____________________________________________
Name & Signature of Applicant/Borrower/Affiant

GSIS ID No.:______________________________
TIN No.:_________________________________
Date:___________________________________

SUBSCRIBED AND SWORN to this _________________ before me a Notary Public for and in the above-
mentioned notarial jurisdiction, applicant personally appeared and exhibits to me his/her proof of identity above
described and who hereby manifests that he/she has voluntarily, freely and knowingly executed, read and
understood his/her affidavit.

WITNESS MY HAND AND SEAL on the date and at the place first written above
Doc. No._____ Book No.______
Page No._____ Series No._____