Republic of the Philippines)

PROVINCE OF SURIGAO DEL SUR) s.s.

C I T Y O F T A N D A G)
X-------------------------------/

AFFIDAVIT OF UNDERTAKING

I, ___________________ , of legal age, Filipino, married, presently

residing at ___________________, after having, been duly sworn to under
oath in accordance with law, do hereby depose and state that:

1. I am the owner of ___________________ of which this backhoe

was used for the purpose of the construction of
___________________;

2. That on ___________________, at ___________________, my

unit or excavator was conducting a loading activity in the said
place in response to the request of ___________________ with
their Barangay Resolution No. 35, Series of 2023, dated Septemer
21, 2023. For reference attached herein the Resolution No. 35
marked as “Annex A”;

3. That the said resolution is the request to put sand and gravel in
___________________;

4. For this reason, I, in my personal capacity as the owner of the

excavator and for my generosity to the barangay officials of
___________________, I agreed to the request of
___________________ to use my excavator for the loading of
sand and gravel for that purpose;

5. For this reason, I am appealing to your good office to consider my

plea and I would like to request to the PNP Station of San Miguel,
Surigao del Sur to release the vehicle for it is necessary;

6. I will cooperate to the PNP Station of San Miguel, as soon as there

is filing of a case or hearing, or I will ensure the delivery of
excavator to the Honorable Court when needed in the course of
the proceeding;

7. That I am executing this Affidavit of Undertaking to attest to all

the above facts.
 IN WITNESS WHEREOF, I have hereunto affix my signature this
___________________, at ___________________.

___________________
Affiant
DL NO.: ___________________

SUBSCRIBED AND SWORN TO before me this

___________________, affiant personally appeared before me exhibited to
me her valid I.D at ___________________.

Doc. No. ____,

Page No. ____,
Book No. ____,
Series of 2023.