Republic of the Philippines)

City of Sorsogon ) S.S.

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AFFIDAVIT OF UNDERTAKING

I, CARLOS M. VALEZA, of legal age, Filipino, married, with residence and

postal address at Purok 1, OLV Pangpang, West District, Sorsogon City, after
having been duly sworn to in accordance with law, hereby depose and say
THAT:

1. I am a physician and currently connected with the Sorsogon Medical

Mission Group Hospital (SMMGH) at Barangay Pangpang, Sorsogon
City;

2. I am the consignee of one (1) PLASTIC ABS FULL DIGITAL ULTRASOUND

DIAGNOSTIC SYSTEM USE FOR FULL DIGITAL ULTRASOUND
DIAGNOSTIC SYSTEM MODEL DW-MU15 HS 901812, with the
descriptions, to wit: HAWB#: 390904953185, Weight: 12 kg, Value:
USD 3800;

3. The said one (1) unit of ultrasound is pending in the jurisdiction of the
Bureau of Customs, Port of Pasay, Pasay City;

4. This medical equipment will be used in the above-stated hospital for

the examination of patients with possible indication of pneumonia and
other related illnesses;

5. As consignee, I hereby undertake to adhere to the existing customs

and allied laws, rules and regulations, and hereby affirms and verifies
that: the subject shipment will be utilized to aid patients with
indications of pneumonia and other related illnesses; the consignee is
amenable to the submission of lacking documents as may be required
by the Port of NAIA; the use of the subject shipment shall only be
undertaken upon issuance of the required clearances; and, other
requirements of the Bureau of Customs for the release of the subject
shipment shall be complied with the moment that government
agencies and offices resume their operations;

6. That this Affidavit of Undertaking is being executed for the purpose of

releasing the above-cited shipment from the Bureau of Customs,
Pasay City;
 7. That, I am executing this affidavit to attest to the truthfulness of all the
foregoing statements.

AFFIANT FURTHER SAYETH NONE.

IN WITNESS WHEREOF, I have hereunto set my hand this _______ day

of_________________ in the City of Sorsogon, Province of Sorsogon,
Philippines.

CARLOS M. VALEZA
Affiant

SUBSCRIBED and sworn to before me this ________________ day of

_________, 2020, affiant personally appeared before me and exhibited to
me his Community Tax Certificate bearing number 18963375, issued on
January 14, 2020 by BLGU Pangpang, Sorsogon City.

Doc. No.:___
Page No.:___
Book No.:___
Series of 2020.