Affidavit of Recognizance in Lieu of Bail

The undersigned, being charged with violation of _____________ for a light felony
punishable by a penalty not higher than 6 months imprisonment and /or fine of not more
than ₱2,000 being unable to post the required cash or bail –bond, hereby binds himself ,
pending final decision of the above – entitled case , to appear before the Court when so
ordered.

The undersigned hereby further binds himself to accept the authority of

_____________ in whose custody he has been placed by the Court.

(Signature of the Accused)

(Signature and address of the Custodian)

Witnesses:

JURAT

RECORD OF APPEARANCE OF ACCUSED BEFORE THE CLERK OF COURT

Dates Signature and Thumb mark of Accused Clerk’s Signature

_____________ ___________________________________ _________________

_____________ ___________________________________ _________________

_____________ ___________________________________ _________________