Republic of the Philippines )

Province of Negros Oriental) S.S.

Municipality of Sibulan)

AFFIDAVIT OF UNDERTAKING

I, SHAQUILLE O. YAŇES, of legal age, single, Filipino, and a resident of Maslog,

Sibulan, Negros Oriental, after having been sworn to in accordance with law, do hereby depose and
state that:

1. I am the possessor/purchaser of a motor vehicle, which is more particularly described

as follows:

MOTOR NO.: JF78E7432160 MAKE: HONDA

CHASSIS NO.: K81P2016578 TYPE OF BODY: MOTORCYCLE
MV FILE NO.: 0701-00001366074 YEAR MODEL: 2022
C.R NO.: 452073602 SERIES: ACH110CSFNII

2. That sometime on May 19, 2023, around 9:00 AM, I was driving the above-described
motor vehicle somewhere in Agan-an, Sibulan, Negros Oriental and was caught by the police of
Sibulan for the violation of Driving without License and without no helmet and the above-mentioned
motorvehicle was impounded;

3. That the said motor vehicle is currently in the possession of the police station of
Municipality of Sibulan, Province of Negros Oriental;

4. That I need the use of the above-mentioned motor vehicle for personal use;

5. That I hereby undertake to surrender the possession or present the above-described

motor vehicle to any court or government entity upon proper notice;

6. I am executing this affidavit to attest to the truthfulness and veracity of the foregoing
facts.

IN WITNESS WHEREOF, I have hereunto affixed my signature this _____________________ in

Sibulan, Negros Oriental, Philippines.

SHAQUILLE O. YAŇES
Affiant

SUBSCRIBED AND SWORN to before me, a Notary Public, on ___________________,

for the Municipality of Sibulan and the Province of Negros Oriental, Philippines, SHAQUILLE O.
YAŇES, who exhibited before me his BIR TIN No. 608-119-354-000, and WHO SIGNED IN MY
PRESENCE the foregoing document (Affidavit of Undertaking), and who avows under PENALTY
OF LAW to the whole truth of the contents of the same.

Doc No. ___;

Page No. ___;
Book No. ___;
Series of 2023.