Republic of the Philippines}

City of Davao…………………..} s.s.

x- - - - - - - - - - - - - -x

AFFIDAVIT OF UNDERTAKING

I, ABCDE, of legal age, Filipino, single and a resident of No. Davao City, Philippines, after
having been duly sworn to in accordance with law, hereby depose and say that:

1. I am the authorized driver of a motor vehicle with plate no. ABC-123 which figured in
an accident last November 7, 2018 at 12:33 a.m. while I was cruising along Loyola
Street corner Porras Street, Bo. Obrero, Davao City.

2. Because of such incident, my driver’s license has been confiscated by the Land
Transportation Office (LTO).

3. I hereby undertake to produce my driver’s license upon request of LTO authorities if

such will be needed for further proceedings or investigation.

4. I am executing this affidavit to attest to the truth of the foregoing facts and to support
my request for the release of my driver’s license.

IN WITNESS WHEREOF, I have hereunto set my hand on this 23rd day of November 2018
at Davao City, Philippines.

ABCDE
Affiant

SUBSCRIBED AND SWORN to before me this 23rd day of November 2018 after affiant
exhibited to me his I.D. No. 12345-67890.

Doc. No.
Page No.
Book No.
Series of 2018.