Republic of the Philippines )

Province of Negros Oriental) S.S.

Municipality of Sibulan)

AFFIDAVIT OF UNDERTAKING

I, NONATO P. RICARDO, of legal age, married, Filipino, and a resident of Agan-an,

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

1. I am the registered owner of a motor vehicle, which is more particularly described as

follows:

MOTOR NO.: TD27-944574 MAKE: NISSAN

CHASSIS NO.: TVP4LEFE24A54998 TYPE OF BODY: VAN
MV FILE NO.: 0701-00000119738 YEAR MODEL: 2015
C.R NO.: 182660844 SERIES: URVAN SHUTTI.E

2. That sometime on July 24, 2023, at about 12:30 MN, I was driving the above-
described motor vehicle somewhere in National Highway, Bolocboloc, Sibulan, Negros Oriental and
figured in an accident;

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.

NONATO P. RICARDO
Affiant

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

for the Municipality of Sibulan and the Province of Negros Oriental, Philippines, NONATO P.
RICARDO, who exhibited before me his Professional Driver’s License No. G02-96-045187 valid
until 2024/04/21, 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.