MC 2018-015 Re: Leased Units

Department of Transportation
Land Transportation Franchising and Regulatory Board
East Ave., Quezon City

SWORN UNDERTAKING

I, _________________________________________________________ of legal age, Filipino, operator of

(_______________________________) and/or duly authorized representative of
(________________________________________), after having been sworn in accordance with law,
hereby declare that:

1. I am the applicant and/or grantee of a Certificate of Public Convenience (CPC) to operate

__________ Service docketed under Case No.____________;

2. The unit proposed to be authorized in the said Application/CPC to operate __________________

is a motor vehicle lease from ______________________________ as the Lessor, under Lease
Contract/Agreement, which is more particularly described hereunder:

MAKE MOTOR NO. CHASSIS NO. PLATE NO. YR MODEL

__________ ________________ _________________ ___________ ____________

3. That being the Lessee of the above described unit, I Undertake to do and perform the following act:
a. To secure the necessary government clearances/permits to legally operate transportation
business;
b. To pay all the expenses such as but not limited to financing costs, taxes and licenses and
for any procedures, such as but not limited to securing government requirements for
roadworthiness and road safety in making the unit legally operational;
c. To submit Official Receipt (OR) and Certificate of Registration (CR) of the above
described unit indicating the name of the Lessor and name of the Lessee;
d. Ensure that the above described motor vehicle shall not be used nor shall allow the said
unit to be used for any illegal purpose.

4. Being the Lessee of the above leased motor vehicle, I further Undertake to assume full
responsibility for any and all obligations and damages that may be incurred in the event of any
untoward incident involving the unit being applied for CPC, and/or in case of violation of any
government laws, policies, rules and regulations and shall indemnify the Lessor, its employees and
agents and render them harmless from any and all claims, actions, suits, proceeding costs, expenses,
damages and liabilities, including attorney’s fees arising from any untoward incident involving the
above described unit;

5. I execute the affidavit to confirm the truth of the foregoing.

IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of ______________ 2018 at
______________________.

_______________________________

Affiant

Subscribed and sworn to before me this ____ day of ______ 2018 with
______________________issued on _____________________ at _____________________.

Doc. No. Notary Public

Page No.
Book No.
Series of 2018