(Republic of the Philippines)

(CITY OF PASIG ) S.S.

AFFIDAVIT OF UNDERTAKING

I, _________________________, _______ years old, Filipino Citizen,

claimant/owner, presently residing at ____________________________, Pasig City After
having been SWORN TO AN OATH IN ACCORDANCE WITH THE LAW, DO HEREBY
DEPOSE AND STATES:

1. That, I am the claimant/owner to claim for the temporary custody of the motor
vehicle which was impounded at the Pasig City Police Station, Vehicle Traffic
Investigation Unit, to wit;

MAKE :
FILE NO. :
MOTOR NO. :
CHASSIS NO. :
REG. OWNER :
ADDRESS :

2. That, in support of the Claim/request for the custody of the motor vehicle (MV)
described above, I have in my possession the following papers:

LTO Certificate of Registration no. :

LTO Official Receipt no. :

3. That said MV is the subject for an investigation being conducted by the Office of
the Pasig City Police Station, Vehicle Traffic Investigation Unit, C. Raymundo
Avenue, Brgy. Caniogan, Pasig City. With such knowledge, said MV will be
presented as evidence if courts require in the appropriate Criminal case.

4. That, pending termination of the Investigation or Resolution of the case involving

the Said MV, I am requesting that said MV be released in my favor/delivered to
my custody temporarily under the following terms and conditions;

a. It is likewise fully understood that the MV is evidence in the investigation

or any appropriate case that was filed in court and as such as, I am under
legal obligation to preserved the same and shall be presented to the
lawful authority anytime when demanded for physical presentation;

b. That, I have no complaint against any of the personnel of the Pasig City
Police Station for any loss or damage sustained by the said MV before its
released/delivery to my custody;

c. That, finally, I hold myself either criminally or civilly liable for Violation of
the above setforth conditions.

IN WITNESS HEREOF, I have hereunto set my hands this _____day of

_____________________, 2019 at Pasig City, Philippines.

_________________________________
(Affiant)