REPUBLIC OF THE PHILIPPINES)

CITY/MUNICIPALITY OF ___________)S.S.

(AFFIDAVIT OF ASSUMPTION OF RESPONSIBILITY)

MASTERLIST OF TRANSPORT UNITS

I, Racquel G. Francisco of legal age, Married and with postal address at

Daan na Cruz, Maasim, San Rafael
after having been duly sworn to in accordance with the law do hereby depose and state that:

1. That, I am the Logistics Supervisor

of RVR Trading ;

2. That, RVR Trading is a legitimate port user engaged

in Trading at the Port of NCR North ;

3. That, said company/firm owns and operates the following transportation/trucking

units which had been issued valid registration, clearance, and permits and for
which I assume responsibility for their legitimate, safe and secure operations;

TYPE MAKE PLATE NO./MV FILE NO.

1. Car FORD NOF 5152
----- nothing follows ------
3.
4.
5.
6.
7.
8.
9.
10.

4. That, this Affidavit is being executed in support of our application for the
issuance of PPA Cargo Vehicle Pass/Sticker for Calendar Year 2022

Racquel G. Francisco
Affiant

SUBSCRIBED AND SWORN to before me this _______ day of _____________ 20_____ the herein
affiant exhibiting his/her Community Tax Certificate No. issued at
_____________ on _______________, 20_______.

(Notary Public)

Doc. No.__________
Page No._________
Book No._________
Series of_________