REPUBLIC OF THE PHILIPPINES)

LAS PIAS CITY

)S.S.
AFFIDAVIT OF UNDERTAKING
I, AILLENE MOROA, of legal age, Filipino, and with residence address at
#14 Agujo St., Phase 1, Casimiro Village , Pamplona 3, Las Pias City, after having
been duly sworn to in accordance with law, hereby depose and say that:
1. I am the registered owner of a motor vehicle which is more particularly
described as follows:
MAKE : MITSUBISHI
ENGINE NO.:
CHASSIS NO.:
TYPE:
WAGON
SERIES :ADVENTURE
MODEL: 2014
CONDUCTION STICKER NO.: BZ 3535
2. On July 13, 2014, I discovered that both left and right side mirror of
said vehicle was lost/missing, and I learned that, there were also victims of same
incident inside our subdivision and our nearby subdivision.
3. The said motor vehicle being an instrument of the said incident / accident.
4. I undertake to bring the said vehicle to the Las Pias City Prosecutors
Office and the proper Court or other government agency, including the Philippine
National Police Headquarters of Las Pias City, at any time the said motor vehicle is
needed for further investigation, ocular inspection, presentation of evidence and
other analogous purposes.
5. I further undertake to be fully liable should I fail to comply with my said
obligation mentioned, and guarantee to keep the said government offices, its
officers, employees and representatives free and harmless from any and all suits of
whatever kind and nature.
6. I am executing this affidavit to attest to the truth of the foregoing facts
and for all its legal intents, effects, consequences and purposes, including to
request the Traffic Management Bureau, Las Pias City for the immediate release of
the said truck.
IN WITNESS WHEREOF, I have hereunto set my hand this July 18, 2014 at
Las Pias City, Philippines.

AILLENE MOROA
Affiant
SUBSCRIBED AND SWORN TO BEFORE ME, this
Pias City, affiant with her competent identification card:
Doc. No. ___
Page No. ___
Book No. ___
Series of 2014.

July 18, 2014 at Las