REPUBLIC OF THE PHILIPPINES )

CITY OF ANGELES ) S.S

AFFIDAVIT OF UNDERTAKING
I, ______________, of legal age, Filipino citizen, single, and a resident of
_______________, after having been duly sworn to, hereby depose and say:

1. That I am the duly authorized representative of 999 Seth Pharmaceutical, Inc.

by virtue of s Secretary’s Certificate dated ________________, which is
attached herewith for ready reference as Annex “A”;

2. That 999 Seth Pharmaceutical, Inc. is the registered owner of the hereunder
described motor vehicle as evidenced by its Certificate of Registration with
No. ______________, a copy of which is herewith attached as Annex “B”;

3. That my said vehicle is hereunder more particularly described as follows:

Make : Isuzu
Model : 1994
Body : Dump Truck
Chassis No. : CXZ71J-3016510
Engine No. : 10PD1-783328
Plate No. : RHY514

4. That said motor vehicle is currently impounded at the Municipal Police Station
of San Antonio, Ajuy, Iloilo on account of the vehicular incident that
transpired on June 29, 2021 at about 12:05 PM along the National Highway of
Brgy. San Antonio, Ajuy, Iloilo.

5. That I intend to have the said motor vehicle released from the custody of the
said Police Station so as not to impair the operation of our company’s business
inasmuch as we have no other motor vehicle available to use pursuant thereto;

6. That I undertake to deliver the subject motor vehicle to any government

entity if there is a need for the inspection or presentation of the same in
court or to the prosecutor’s office concerned in the event a case is filed in
court on account of the aforementioned traffic incident;

7. I affirm that I understood all the contents of this Affidavit.

8. That I am executing this affidavit to attest to the truth and fact of my foregoing
statement, and to inform the proper authorities that I undertake to present and
deliver the subject motor vehicle to any government entity if there is a need for
the inspection or presentation of the same in court or to the prosecutor’s office
concerned in the event a case is filed in court on account of the aforementioned
traffic incident; and for such other purpose/s that it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this __ day of June

2021 in City of Angeles.

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 ___________________________
Affiant

SUBSCRIBED AND SWORN to before me in the City of Angeles this

___ day of ___2021 by affiant who exhibited to me his Driver’s License with No.
___________, expires on ________________, known to me and to me known to
be the same person who personally signed before me the affidavit of undertaking
and acknowledged that he executed the same.

NOTARY PUBLIC

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