RSD DPRM FORM 2015-1A
Republic of the Philippines
National Police Commission
NATIONAL HEADQUARTERS, PHILIPPINE NATIONAL POLICE
Camp Crame, Quezon City
AFFIDAVIT OF UNDERTAKING
[POLICE OFFICER 1 PSF QUOTA APPLICANT]
I, ____________________________________________________ of legal age,
(First Name)
(Middle Name)
(Last Name&/Qualifier)
Filipino and presently residing at _______________________________________ after having
duly sworn to in accordance with law, do hereby depose and state:
1. That I am a Police Officer 1 (PO1) applicant for this CY ________ Regular Recruitment
Program of ______________________;
(unit/office)
2. That I was born on _________________________;
3. That I am a graduate of __________________________________ and holder of
________________________ eligibility;
4. That I have not been dishonourably discharged from military employment or on Absence
Without Official Leave or Dropped from Rolls from the PNP service or dismissed for cause from
any civilian position in the Government.
5. That I have no pending criminal case in any court, including at the Office of the
Ombudsman or administrative case;
6. That I have not been convicted by final judgment of an offense or crime involving moral
turpitude;
7. That I agree to the automatic nullification of my appointment as Police Officer 1 and
hold myself liable for perjury, falsehood, misrepresentation or omission of facts, if there exists a
pending case against me and/or falsification or act of dishonesty for any fraudulent, fake or
tampered documents that I have submitted;
8. That I will not resign from the service within three (3) years after having taken my oath of
office nor seek reassignment/detail with other PNP units or allied services outside of
_____________ for at least five (5) years;
(unit)
9. That I further certify that the foregoing declarations are true and accurate to the best of
my knowledge and ability and I hereby authorized the PNP to obtain and secure pertinent
records that will show my qualifications standards, collateral requirements and case records and
other record related to these declaration if any, in any agency or office.
FURTHER AFFIANT SAYETH NONE:
_______________________________________
(Affiant’s Signature Over Printed Name)
SUBSCRIBED AND SWORN to before me this _____ day of __________, 2015 at
_________________________________, Philippines, affiant exhibiting his/her CTC No.
____________________ issued at ___________________ on ________________.
____________________
NOTARY PUBLIC