Republic of the Philippines)

City of Sorsogon )S.c.

AFFIDAVIT OF UNDERTAKING

I, NIŇA CARLA L. DOMINGUIANO, of legal age, Filipino, and a resident of

483 Magsaysay St., Cogon, Sorsogon City, after having been duly sworn in accordance
with law, hereby depose and say:

1. That I am the owner of a Honda City Sedan bearing plate no. ZMS554, Motor no.
REGD01-8402582 and Chassis no. PADCD65108V402588 having bought the
vehicle from the registered owner RADIOWELATH FINANCE CORP on June 2,
2020 in a Deed of Sale duly notarized by Atty. Jad S. Estopa under Doc no. 126, Page
no. 27, Book no 5 Series of 2020;

2. That on July 31, 2020 at around 6:25 PM, as my vehicle was being driven by ALVIN
DOLLESIN STA MARIA, along Diversion Rd., Brgy. Macabog, Sorsogon City, he
accidentally bumped a Toyota Avanza bearing plate no. EAD3351 driven by Brian
Roy Miranda Lacerna, causing damages yet to be determined by mechanic to both
vehicles;

3. That by reason of the said incident, the vehicle is now in possession of the Sorsogon
City Police Station at Brgy. Cabid-an, Sorsogon City;

4. That I hereby warrant that I as the owner of the vehicle, have the authority to take
custody and possession thereof and I hereby undertake to present the same before
any government agency, court of tribunal upon orders and whenever required to do
so;

5. That I am executing this affidavit to prove and to attest to the truth of the foregoing
facts and for any legal purposes this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

_________________ at Sorsogon City.

NIŇA CARLA L. DOMINGUIANO

SUBSCRIBED AND SWORN to before me this ______________ at Sorsogon

City, affiant having presented to me her LTO Driver’s License bearing no. E05-09-
001459.

Doc No. _____

Page No. _____
Book No._____
Series of 2020