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    MEMORANDUM OF UNDERTAKING Final

    Uploaded by

    Alvin Barce
    This memorandum of undertaking summarizes deficiencies found during a 2018 facility monitoring visit and outlines commitments to address them. The owner pledges to comply with personnel, physical plant, equipment, and other requirements. The license to operate will be deemed ineffective until full compliance is achieved, and the facility may be ordered to cease operations. The owner signed acknowledging these terms.

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    © All Rights Reserved
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    MEMORANDUM OF UNDERTAKING Final

    Uploaded by

    Alvin Barce
    3K views2 pages
    This memorandum of undertaking summarizes deficiencies found during a 2018 facility monitoring visit and outlines commitments to address them. The owner pledges to comply with personnel, physical plant, equipment, and other requirements. The license to operate will be deemed ineffective until full compliance is achieved, and the facility may be ordered to cease operations. The owner signed acknowledging these terms.

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    This memorandum of undertaking summarizes deficiencies found during a 2018 facility monitoring visit and outlines commitments to address them. The owner pledges to comply with personnel, physical plant, equipment, and other requirements. The license to operate will be deemed ineffective until full compliance is achieved, and the facility may be ordered to cease operations. The owner signed acknowledging these terms.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    3K views2 pages

    MEMORANDUM OF UNDERTAKING Final

    Uploaded by

    Alvin Barce
    This memorandum of undertaking summarizes deficiencies found during a 2018 facility monitoring visit and outlines commitments to address them. The owner pledges to comply with personnel, physical plant, equipment, and other requirements. The license to operate will be deemed ineffective until full compliance is achieved, and the facility may be ordered to cease operations. The owner signed acknowledging these terms.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    Republic of the Philippines )

    Legazpi City ) S.S

    MEMORANDUM OF UNDERTAKING

    KNOW ALL MEN BY THESE PRESENTS:

    I, __________________________, owner/head of facility of


    __________________________located in _________________________, under oath, aver, as
    follows:
    1. That above named facility was found to be deficient of some requirements during 2018
    monitoring visits, to wit:

    a. Personnel Complement

    b. Physical Plant

    c. Equipment/Instruments

    d. Others

    2. That in view of our application for renewal of 2019 License to Operate, I undertake to
    comply with the above requirements, under the following conditions:

    a. That until such time that the facility completely comply with the above
    requirements, the License to Operate of the facility shall be deemed ineffective and
    shall be validated only after full compliance of the requirements.

    b. That upon order of Department of Health Center for Health Development – Bicol,
    the facility shall cease and desist from operating until the License to Operate
    becomes valid.

    IN WITNESS WHEREOF, I have been hereunto set my hand this _ _ day of _ _ _ _ _ _ _ _ _


    _, 2018 in _____________.

    _______________________
    Owner/ Head of Facility
    SIGNED IN THE PRESENCE OF:

    1. ______________________________ 2. _______________________________

    ACKNOWLEDGEMENT
    REPUBLIC OF THE PHILIPPINE )
    PROVINCE OF _________ ) S.S
    MUNICIPALITY OF ________

    BEFORE ME, notary public for and in the above jurisdiction, this __th day of _______,
    personally appeared:

    NAME GOV’T ISSUED ID NO. Issued by:

    _______________________ ______________________ _________________


    _______________________ _______________________ _________________

    All known to me and to me known to be the same persons who executed the foregoing
    instrument and they acknowledged to me that the same is their free and voluntary act and deed.
    This instrument consisting of two pages (2) pages, including the page where this
    acknowledgement is written has been signed by concerned party on each and every page
    thereof.

    IN WITNESS WHEREOF, I have hereunto set my hand in the place and date above written.

    Doc. No. ____ NOTARY PUBLIC

    Page No.____

    Book No. ____

    Series of 2018

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