Republic of the Philippines

Cagayan de Oro City S.S.

Misamis Oriental

AFFIDAVIT OF UNDERTAKING OF NON-PENDING CASE

I, Kimberly-jean Cabiling Ragmac, of legal age, residing at Gusa, Cagayan de Oro City, a Licensed
Chemist, previously working as Assistant Instructor III at Xavier University – Ateneo de Cagayan, Cagayan de
Oro City, Misamis Oriental after having been sworn to in accordance with law, do hereby depose and state that:
1. I am a Licensed Chemist who took the Board Examination for Chemistry last October 4-5, 2016;
2. I possess all the mandatory qualifications (i.e. eligibility, training, diploma, transcript of records) and
other collateral requirements for PNP Lateral program;
3. All the documents I have submitted to support my PNP Lateral Application are accurate, genuine and
authentic and that all the originals are now with me ready for verification and/or comparison anytime;
4. I am fully aware of my liability and responsibility in the foregoing declaration under the law and
regulation of the PNP, NAPOLCOM and CSC;
5. I agree to the AUTOMATIC NULLIFICATION of my PNP Lateral Application and hold myself
administratively and criminally liable for “DISHONESTY” and “PERJURY” for falsehood, misrepresentation or
omission and for fraudulent, falsification or tampered documents that I have submitted;
6. I have read and checked all entries appearing in my attached CSC Personal Data Sheet and that I certify
all entries thereof are true and correct;
7. I further certify that the foregoing declarations are true and correct to the best of my knowledge and
ability and I hereby authorized the PNP to obtain and secure pertinent records that show my qualification
standards, collateral requirements and case records and other record related to this declaration if any, in any
agency or office;
8. Since the pendency of my appeal/grievance/complaints for PNP Lateral renders this application moot
and academic, I hereby voluntary withdraw said appeal/grievance/complaints for purposed appointment;
9. I have criminal and/or administrative case; YES NO
I was suspended from my previous work; YES NO
I was demoted from my previous work; and YES NO
An appeal is pending lieu therefore, before any judicial
and administrative or quasi-judicial bodies; YES NO
10. I have attached the certification from the court and quasi-judicial body on the status of the case. If
applicable; YES NO
The following are the details of my pending criminal and/or admin case(s) and record(s) of
suspension/demotion from my previous rank;
NATURE OF CASE TITLE/ CASE DATE FILED/
COMPLAINT/ COMPLAINANT NUMBER AND STATUS PENALTY/ PERIOD
OFFENSE VENUE (Pending or DECISION PENALTY
Resolved) IMPOSED

Note: Use Extra Sheet if necessary

THAT, I attest to the truthfulness of the foregoing declaration and submit myself to the legal
consequences thereof, if ever the statements above are wanting in truth and substance.

Affiant

SUBSCRIBE AND SWORN TO before me this day of 2017 at

, Philippines.