Republic of the Philippines )

_____________________ ) SS.

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AFFIDAVIT OF UNDERTAKING FOR TERMINAL LEAVE

I, _______________________________, of legal age, Filipino, single/married/widow/widower and a resident of ___________________________ after having been duly sworn to in accordance with law, hereby voluntarily depose and say:

1. That I am presently employed in the Commission on Audit and due for compulsory/optional retirement on ______________________________.

2. That I have applied for Terminal Leave effective _______________________.

3. That pre-audit of financial transactions of national government agencies, among others, has been lifted per COA Circular 2011-002 dated July 22, 2011.

4. That should it appear in post-audit there was overpayment in the money value of my terminal leave, I am willing to refund of any excess amount thereon;

5. That on the other hand, if it will appear in post-audit that I was underpaid in my terminal leave benefits, it is understood that the Commission on Audit shall pay me the difference of the amount corresponding to the underpayment; and,

6. That I am executing this affidavit to attest to the truth to all the above facts.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of ___________ 20____ in ____________, _____________, Philippines.

___________________________________

Affiant

SUBSCRIBED AND SWORN TO before me this _____ day of _________ at ________________ affiant exhibited to his/her competent evidence of identity by way of _________________ issued on __________________ in _______________, Philippines.

Notary Public

Doc. No. ______;

Page No. ______;

Book No. ______;

Series of ______;