Republic of the Philippines)

CITY OF DAVAO )S.S

AFFIDAVIT OF UNDERTAKING
I, JOHN SNOW, Filipino, of legal age and a resident of, Suazo St., Davao
City, after having been duly sworn in accordance with law, hereby depose
and say:
1. That I am the registered owner of a motor vehicle with a Certificate
of Registration No. 123421 issued by the Land Transportation
Office, more particularly described as follows:
MAKE:Toyota RUSH
Model: 2020
Type: Pick-up
Engine No.: XC123333
Chassis No.:c121827172
Plate No.: XXX 1234

2. That my above vehicle has met with an accident at Nabunturan on

October 24, 2020 at about 4:30 in the aftermoon;
3. That the above-mentioned vehicle has is presently under the custody
of the Police;
4. That I am requesting the above-mentioned vehicle together with
the necessary documents and license be released to my
representative as soon as I comply with the requirements, so I can
take it for necessary repairs immediately;
5. That the above-mentioned motor vehicle is insured as per
registration requirements of the Land transportation Office and that
any liability that might be judicially determined against me is covered
by my insurance policy.
6. That I solemnly affirm and declare that this affidavit of mine is
correct and true to the best of my knowledge and no part of it is
false and nothing material has been concealed therein;

JOHN SNOW
Affiant

SUBSCRIBED AND SWORN to before me this 6th day of November , 2020.

Affiant exhibiting to me his evidence of identity
______________________.