REPUBLIC OF THE PHILIPPINES

______________________________ S.S.

AFFIDAVIT OF UNDERTAKING

I, _____________________, of legal age and with office address at

_______________________________, under oath, hereby depose and
state:

1. I am the__________________, with address as above-stated;

2. That on 04 August 2019, a motor vehicle registered in the

name of ______________ (“Subject Vehicle”) figured in a vehicular
accident, with the following details:

Make: Motor No:

Series: Serial/Chassis No.:
Type of Body: Plate No.:
Year Model: File No.:
O.R.: C.R.:

3. I am attaching herewith a machine copy of the Official

Receipt and Certificate of Registration issued by the Land
Transportation Office as proof of the Subject Vehicle’s due registration;

4. Upon official orders by the appropriate authorities, I hereby

commit to present the Subject Vehicle to the appropriate authorities for
purposes of investigating the vehicular accident. I likewise commit not to
dispose/deliver/assign/waive/mortgage the Subject Vehicle, at any time
during the investigation/pendency of the proceedings involving the
vehicular accident, and to preserve the integrity and identity/present
state of the Subject Vehicle.

5. I am executing the foregoing affidavit to attest to the truth of

the foregoing, and for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand on this

____ day of ___________ 2019 at _______________, Philippines

__________________________
Affiant

1
 SUBSCRIBED AND SWORN to before me this
________________ in ____________ by affiant who has satisfactorily
proven to me his identity through his ID ____________________ that he
is the same person who personally signed before me the foregoing
verification and acknowledged that she executed the same.

Doc. No.: _____;

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