REPUBLIC OF THE PHILIPPINES )

___________ ) S.S.

AFFIDAVIT OF UNDERTAKING

I, _________________, of legal age, single, Filipino with postal

address at ______________________ after having been sworn in
accordance with the law hereby depose and state that:

1. I am a driver of a motor vehicle with plate no. _______ which figured

in an accident;

2. Sometime last JULY 25, 2012 approximately Twelve o’çlock in the

afternoon, I was a party to an accident whereby I accidently
sideswiped a person in the name of ____________ while I was trying
to avoid a collision between a bicycle;

3. Because of such incident, the vehicle that I was driving was

impounded by the authorities;

4. I hereby undertake to produce said vehicle upon request of the

authorities if such will be needed for further proceedings or
investigation;

5. This affidavit is being executed to support my request for the release

of the impounded vehicle;

6. I am executing this undertaking to attest to the truth of the

foregoing.

IN WITNESS WHEREFOR, I have hereunto set my hands this ______ day of

_______________, 2012 in Naga City, Philippines.

________________

SUBSCRIBED AND SWORN TO before me this _____ day of ________, 2012

in the City of Naga, Affiant Exhibiting to me his _____________ issued on
December 15, 2011 in Manila, Philippines.

Doc No.
Page No. Notary Public
Book No.
Series of 2012