Republic of the Philippines)

Province of Masbate ) S.S.

City of Masbate )

AFFIDAVIT OF UNDERTAKING

I, Jovely B. Galvez., of legal age, Filipino and a resident of Brgy. Poblacion,Balud

,Masbate after having been duly sworn to in accordance with law, hereby depose and say:

That I am a Licensed Pharmacist with PRC LICENSE NO. 0042038 and the Pharmacist of
Carl John Pharmacy located at Poblacion , Balud, Masbate;

That I commit that every time John Carl Pharmacy is open for business, I being the
pharmacist will personally supervise and be physically present at all times at the business place
in compliance with Section 27 of RA 5921:
AN ACT REGULATING THE PRACTICE OF PHARMACY AND SETTINGS
STANDARDS OF PHARMACEUTICAL EDUCATION IN THE PHILIPPINES AND OF OTHER
PURPOSES.

Further I certify that I will not Violate any acts which is contrary to the Food and Drug
Admistration rules/law on Practice of Pharmacy;

That I have executed this affidavit to attest to the truth of all the foregoing and for
whatever purpose this affidavit may serve.

IN WITNESS WHEREOF, I have hereunto set my hands this ___________________ in the

City of Masbate, Philippines.

__________________________
Affiant

SIGNED IN THE PRESENCE OF:

_______________________ _______________________

JURAT

SUBSCRIBED AND SWORN to before me this _________________affiant exhibited to

me her PRC ID no. 0042038 valid until May 19, 2019.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2017;