AFFIDAVIT OF NON-ISSUANCE OF CR

W/UNDERTAKING

I JOSE A. BATIONG, of legal age, Filipino and a resident of Brgy. Suclayin Baler
Aurora, after being sworn to in accordance with law, do hereby depose and say:

1. That I am the registered owner of a certain vehicle described below;

Make: Isuzu
Type: Dump Truck
Motor No: D500435151
Chassis No. CCKW-353-190857
PLATE NO. CEY-556
File No. 0312-180

2. That no CR were issued on the above subject MV upon its registration

3. That I am responsible for the issuance of any document regarding the

aforementioned vehicle, and that I take it upon myself to answer for any liability
that may arise in connection with any claim regarding ownership of the same, and
hereby declare the LTO officials who may hereafter release the Certificate of
Registration in my name, are exempt from any liability thereof.

4. This affidavit is executed to me to attest to the truth surrounding the above stated
facts.

AFFIANT FURTHER SAYETH NAUGHT

JOSE A. BATIONG
Affiant

SUBSCRIBED AND SWORN to before me this

________________________________ at Baler Aurora, affiant exhibited to me his/her
Residence Certificate No. 26892561 issued at Baler Aurora on 10 June 2011.

Doc. No.____________________
Page No.____________________
Book No.____________________
Series of 2011