Republic of the Philippines)

Province of Leyte ) s.s.

Municipality of __________)

AFFIDAVIT OF UNDERTAKING
I, ______________________, 35 years old, married, Filipino, Cignal Installer
and a resident of ______________________Leyte having been subscribe to an
oath, in accordance with law, hereby depose and say;

1. That I live in Channel Ridgeview Subdivision Poblacion District I,

Babatngon leyte and that __________________ is my neighbor and live just across
my house;

2. That on January 01, 2023 an incident happens involving myself and

____________ at our place of residence where we are celebrating the New Year,
where due to my intoxication I was not aware that I was able to throw something into
a random direction which hit the door of the house of _______________ which
cause his live-in partner to be startled and called him at the Police Station;

3. That upon arrival of _________________ in our place, he saw me together

with my other friends drinking at the street, he came to immediately an push me
forcefully which cause me to fall on the ground;

4. That after the incident, I went to the Police Station to report the said
incident wherein the investigatr after getting the details gave me a medical request
and I was advised to proceed to the Rural Health Unit for a Medical Examination for
me to obtain a medical certificate that may help me and use in filling a complaint
against ______________:

5. That I was advised by the investigator on case _______________ as well

as their Acting Chief of Police to comeback at the station after the medical
treatment, purposely to file the necessary complaint against
______________________;

6. That I fail to comeback at the station because I feel the need to consult my
family regarding the action that I may take and that my family and I decided to
consult a lawyer for a legal advice on the matter;

7. That on the next day January 2, 2023 the Investigator from Babatngon
Police Station visited me and my family making a follow-up on my complaint but my
family and I decided that the said matter is only trivial to be brought up to court and
to incur expenses, thus, we decided to confront _________________ regarding the
matter at the office of the barangay where the incident transpired and where we both
live;
 8. That it is my own decision concurred by my family to settle such trivial
matter between neighbors in the barangay, wherein during our confrontation at the
barangay, we voluntarily come to a settlement after the respondent humbled himself
by asking for my forgiveness;

9. That I am executing this affidavit to attest the truthfulness of the foregoing

facts and circumstances and the same is true based on my personal knowledge and
understanding.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ______

day of January 2023 at ___________________, Leyte, Philippines.

_________________________
Affiant

SUBSCRIBED AND SWORN to before me this this _______ day of __March,

2023 at ______________________, Leyte, Philippines. Further certifies that I have
personally examined the affiant and that I am satisfied that he executed this affidavit
and understood the contents hereof.

__________________________