Republic of the Philippines )

City of Baguio ) S.S.

AFFIDAVIT OF UNDERTAKING

I, ___________ of legal age, single and a resident of #_______ after having been
duly sworn on oath in accordance with law, do hereby depose and say:

1) That I had been involved in a vehicular accident around 9:00 pm of September

7, 2019 along ____________ being the driver of a Toyota Rush with _________ which was
bumped by a _____________ driven by __________;

2) That my Non-Professional Driver’s License bearing the number ___________

had been confiscated by the Traffic Accident Investigators who assessed the incident;

3) That because of failure of any amicable settlement, I had caused the filing of a
criminal case against ______________ and the same is pending before a judicial body
specifically in Branch 1, Municipal Trial Court in Cities situated in the City of Baguio;

4) That no charge nor counter-charge has been filed against my person in any court
or forum to the best of my knowledge;

5) That I undertake to comply with any lawful order of this office with utmost
good faith.

IN WITNESS WHEREOF, I have hereunto signed my name below this 3rd day of
December 2019 at Baguio City, Philippines.

______________
Affiant

SUBSCRIBED AND SWORN TO before me this 3rd day of December 2019 at

Baguio City, Philippines affiant exhibiting to me his competent evidence of identity.

Doc. No. 134;

Page No. 27;
Book No. I;
Series of 2019.