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IN THE CITY OF __________) S.S.

I, ________________, of legal age, Filipino, and resident of _______________________,
after having been duly sworn to in accordance with law, hereby depose and state THAT:

1. I am the event organizer of the planned disco at __________________;

2. On the occasion of our Annual Fiesta, the aforementioned barangay sector will
be holding a Disco Activity this coming _____________ from _________ to __________;
3. In connection of the abovementioned event, I undertake that I shall submit to the
City a detailed security plan, disaster plan and traffic plan that will be observed
for the duration of the event;
4. I shall ensure that all parking lots must remain open and should not be converted
into additional space for patrons or for any other purpose;
5. I will make sure that there will be proper entrance and exit zones which will be well
identified and well lighted so as to guide the patrons in case of emergency;
6. I shall maintain peace and order for the whole duration of the party;
7. I will make sure that all traffic and pedestrian lanes must not be obstructed;
8. There will be no liquor and cigarettes may be sold to patrons less than 18 years of
9. I shall regulate the use of loud speakers or similar contrivance so as not to
constitute a nuisance;
10. I will make sure that personnel from the Disaster Risk Reduction and Management
Office, Bureau of Fire, Philippine National Police, City Legal Office, City Health
Office and alike departments must be given access all the time to conduct an
inspection so as to ensure that the continuing conditions imposed by the city;
11. I will ensure the proper disposal of the garbage in connection to the said event;
12. There will be no lewd or any immoral act shall be part of the format of the event
or show. I ensure that our patrons will not be involved in any indecent/immoral
act during the duration of the event;
13. I will comply with Ordinance No. _____ as to curfew for minors;
14. There will be no acts prohibited by law or city ordinance should be committed
during the event;
15. I execute this affidavit to undertake the foregoing conditions and to support the
approval of my application for permit, in behalf of ____________________.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ____ day of

____________ 2019, at _____________, Philippines.

ID No. 12345

SUBSCRIBED AND SWORN to before me this ___ day of _____ 2019, at

_________________, affiant sufficiently proved to me his/her identity by exhibiting his/her
ID, as shown above.

Doc. No: ____________;

Page No: ____________;
Book No: ____________;
Series of 2019.