lOMoARcPSD|39185525

Affidavit OF Undertaking Vehicle

Law (San Beda University)

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 lOMoARcPSD|39185525

REPUBLIC OF THE PHILIPPINES )

MUNICIPALITY OF PILAR ) S.S.

AFFIDAVIT OF UNDERTAKING

I, MARIA TERESA MICOSA NAVERA, of legal age, married, Filipino, a resident of Brgy.
Camaya, Mariveles, Bataan, after having being duly sworn to in accordance with law, do
hereby depose and state that:

1. I am the owner of the motor vehicle involved in an accident in Lubao,

Pampanga:

MAKE/TYPE : TOYOTA
SERIES : INNOVA
MV FILE NO. : 1340-00000430991
CHASSIS NO. : PAEVB5MH9AB001842
ENGINE NO. : 4D56AAD0367
BODY TYPE : WAGON

2. In support of my request for custody of said vehicle, I have in my possession

the following papers marked as Annexes “A” and “B”, as proof of ownership and
registration.

a. Official Receipt with No. 1022290172

b. Certificate of Registration with No. 10357994-3

3. I undertake to maintain the color and not to alter the appearance of the same
so as to make it identifiable by any witness who may be called upon to identify it.

4. I further bind myself to present the same whenever required by this Office and
by the Honorable Court.

5. I am executing this affidavit of undertaking to attest to the truth of the

foregoing and to ask for the release of the said motor vehicle.

IN WITNESS HEREOF, I have hereunto set my hand this 10th day of January, 2018
in the Municipality of Pilar, Bataan.

MARIA TERESA MICOSA NAVERA

Affiant

SUBSCRIBED AND SWORN to before me this 10th day of January, 2018 in Pilar,
Bataan. Affiant has successfully proven her identity to me through her Social Security
System Identification card with No. 02-0856440-3 issued by the Social Security System
bearing her photograph and signature.

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