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Republic of The Philippines) Province Of) S.S Municipality Of) X - X

The document is an affidavit of undertaking from a driver involved in a vehicular accident. It states that the driver was operating an ambulance owned by the local government when it collided with a motorcycle on November 27, 2015. As a result, the driver's license was confiscated by police. The driver requests the return of the license pending resolution of the case and undertakes to present the license whenever required. The affidavit is signed and notarized on December 10, 2015 in Camarines Norte, Philippines.

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marjorie
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100 views2 pages

Republic of The Philippines) Province Of) S.S Municipality Of) X - X

The document is an affidavit of undertaking from a driver involved in a vehicular accident. It states that the driver was operating an ambulance owned by the local government when it collided with a motorcycle on November 27, 2015. As a result, the driver's license was confiscated by police. The driver requests the return of the license pending resolution of the case and undertakes to present the license whenever required. The affidavit is signed and notarized on December 10, 2015 in Camarines Norte, Philippines.

Uploaded by

marjorie
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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REPUBLIC OF THE PHILIPPINES )

PROVINCE OF )S.S
MUNICIPALITY OF )
x---------------------------------------------------------x

AFFIDAVIT OF UNDERTAKING

I, __________________, of legal age, married, Filipino citizen and resident of


Purok 1, Barangay ______________, Camarines ____________, after having been duly
sworn to in accordance with law, hereby depose and say:

1. That I am the authorized driver of an ambulance owned by LGU,


____________, Camarines and as such, I am a holder of Professional Driver’s
License No. E01-75-003195 issued by the LTO, Daet, Camarines Norte;
2. That sometime on November 27, 2015, while I was driving the said ambulance
in front of the __________________, it was involved in a vehicular accident
with a motorcycle;
3. That as a result of that accident, my driver’s license was confiscated by members
of PNP;
4. That I executed this affidavit in good faith to request from the Chief
______________or any person acting in his behalf, to release the said driver’s
license to my custody pending resolution of the case, if there is any;
5. That I hereby undertake to present and/or surrender the said driver’s license
whenever it is required by the court or by the police authorities for proper
identification/disposition or for other purposes relative to the case;
6. That all the statements above are true and correct to the best of my knowledge
and belief.

IN WITNESS WHEREOF, I have hereunto set my hand this 10th day of


December 2015 at __________________.

__________________
Affiant

SUBSCRIBED AND SWORN to before me this 10th day of December 2015 at


Labo, Camarines Norte, affiant exhibited to me his VIN ID #

Doc. No._____________ NOTARY PUBLIC


Page No._____________
Book No.____________
Series of 2015.

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