Republic of the Philippines)

Province of Ilocos Sur )S.S.

City of ________________)

REQUEST OF RELEASE WITH UNDERTAKING

I, ____________, of legal age, Filipino, and a resident of
_________________________, after having been sworn to in accordance
with law hereby depose and state:
1) That I am the registered owner of a motor vehicle particularly
described as follows:
MAKE: TOYONA SERIES/MODEL: OSO 2006
PLATE NO.: XYZ 1212 ENGINE NO.: 1212345
BODY TYPE: 2-DOOR MV FILE: 12341111

2) That I hereby request for the release of the MOTOR VEHICLE

above-described which is presently in the custody of the Police Station, by
virtue of the filing of RIR Homicide against the respondent herein;
3) That the said property is not an instrument or tool for the
commission of any offense.
4) That should the said vehicle be needed in the course of the
hearing/trial of this case, I undertake to deliver and surrender it to the
court;
5) That this affidavit is executed in order to attest to the veracity of
the averments stated herein and for whatever legal purpose this may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this
______________ at _________________________.

_____________________
Affiant
ID/Passport No. _______________
____________________________
SUBSCRIBED AND SWORN TO Before me this _________ at
________________________. The affiant is personally known to me.