Affidavit-of-Undertaking DA

Download as docx, pdf, or txt
Download as docx, pdf, or txt
You are on page 1of 1

REPUBLIC OF THE PHILIPPINES )

___________ ) S.S.

AFFIDAVIT OF UNDERTAKING

I, John Laurence A. Pacsial, of legal age, single, Filipino with postal


address at Block 15 Lot 2 Lotus Lakeside Village Molino 3 Bacoor City, Cavite
after having been sworn in accordance with the law hereby depose and state
that:

1. I am a driver of a motor vehicle with plate no. NFW 7535 which


figured in an accident;

2. Sometime last December 6, 2020 approximately Four Thirty in the


afternoon, I was a party to an accident whereby I accidently
sideswiped a person in the name of Jacob Bernard Valo while I was
trying to avoid a collision between a bicycle;

3. Because of such incident, the vehicle that I was driving was


impounded by the authorities;

4. I hereby undertake to produce said vehicle upon request of the


authorities if such will be needed for further proceedings or
investigation;

5. This affidavit is being executed to support my request for the release


of the impounded vehicle;

6. I am executing this undertaking to attest to the truth of the


foregoing.

IN WITNESS WHEREFOR, I have hereunto set my hands this ______ day of


_______________, 2021 in Bacoor City, Cavite.

________________

SUBSCRIBED AND SWORN TO before me this _____ day of ________, 2021


in the City of Bacoor, Affiant Exhibiting to me his Driver’s License issued on
January 10, 2019 in Pasay, Philippines.

Doc No.
Page No. Notary Public
Book No.
Series of 2012

You might also like