REPUBLIC OF THE PHILIPPINES)

PROVINCE OF ___________) S.C.

MUNICIPALITY OF __)

AFFIDAVIT OF UNDERTAKING AS CUSTODIAN

I, _________________, Filipino, of legal age and a resident of Brgy.

______________, after having been duly sworn to in accordance with law, depose
and state, that:

1. I am the incumbent Punong Barangay of Brgy. ______________;

2. ________________ is a former resident of Barangay _____________;

3. I was informed that ________________ has applied for probation having

been convicted for the crime of ____________________________ by the
Regional Trial Court of Malaybalay City, Bukidnon, Branch ____, and docketed
as Criminal Case No. ________________;

4. I was further made to understand that __________ desires to be released

on recognizance pending the resolution of his application for probation, and
needs a custodian for this purpose;

5. I hereby agree to be the said custodian of _______________ and

undertakes to bring him to court whenever required;

6. I am executing this affidavit to apprise all those concerned of the foregoing

facts and for whatever other legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 5 th day of

February 2020, at _______________, Philippines.

_______________________
Affiant

SUBSCRIBED AND SWORN to before me this 5th day of February 2020, at

Wao, Lanao del Sur, Philippines. The identity of the affiant is established by his DILG
ID No. _______________.