AFFIDAVIT OF UNDERTAKING
I.MARK ANTHONY LONGALONG, of legal age. Filipino citizen. and residing 133C BUKIDNON ST.,
CORNER ILOCOS SUR ST., RAMON MAGSAYSAY DISTRICT 1, QUEZON CITY after being duly sworn to
in accordance with the law. do hereby depose and state that:
1. That, I am the owner of AYANAH WATER STATION located at 133C BUKIDNON ST., CORNER
ILOCOS SUR ST., RAMON MAGSAYSAY DISTRICT 1, QUEZON CITY which is engaged in WATER
REFILLING STATION
2. I acknowledge that the Quezon City Health Department has identified our business
establishment as one of the non-compliant establishments that did not apply for a Sanitary
Permit for the year 2023-2024
3. I understand that the failure to apply for a Sanitary Permit is a violation of the regulations set
forth by the Quezon City Health Department which is essential for ensuring the health and
safety of the people we serve
4 I thus declare that the cause for our failure to campy with the Sanitary Permit requirement
for the year 2023-2024 was failure to address.
5. I Acknowledge the importance of complying with all regulatory requirements. Including but not
limited to obtaining a Sanitary Permit. to ensure the safe and sanitary operation of our
business.
6 I hereby undertake to follow all regulatory requirements imposed by the Quezon City Health
Department for our business including the annual application for and renewal of the Sanitary
Permit. as well as any other requirements that may be required based on the nature of our
business
7. I understand that failure to comply with these undertakings may result u, penalties. fines. or
other legal actions as provided for by law
8 I affirm that the statements made herein are true and correct to the best of my knowledge and
belief.
9. I also affirm that I have attached an necessary documents and requirements as stipulated by
the Quezon City Health Department for the application of the Sanitary Permit.
IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of ___________,in
Quezon City.
MARK ANTHONY LONGALONG
Signature of Affiant
SUBSCRIBED AND SWORN to before me this ________. Affiant who exhibit to me his/her
competent evidence of identity as shown by __________ No. _________ issued on ________ , at
______________________.
NOTARY PUBLIC
Doc No:______
Page No:_______
Book No:_______
Series of 20____
