Republic of the Philippines

Province of Pampanga )
x-------------------------------x

)
S. S.

AFFIDAVIT OF UNDERTAKING
I, ROBERTO D. CAYETANO, JR., of legal age, Filipino, married, and a
resident of Barangay Pulong Bayabas, San Miguel, Bulacan, Philippines,
having been duly sworn in accordance with law, hereby depose and state:
1. That, the herein affiant with residential address at Barangay Pulong
Bayabas, San Miguel, Bulacan, is the registered owner of an Isuzu
Dump Truck with plate RJM588, copy of the Official Receipt/Certificate
of Registration (OR/CR) attached hereto as Annex 1;
2. That, the said motor vehicle was involved in a vehicular accident on
September 25, 2016 at about 11:00 in the evening along McArthur Hiway, in front of Total Gasoline Station, Barangay Mabiga, Mabalacat
City, Pampanga causing the death of ARNEL SOLIMAN y PINEDA;
3. That, the above motor vehicle has been impounded and presently
under custody of the Porac Municipal Police Station;
4. That I need the above vehicle to earn a living and for some other legal
purposes as its owner;
5. That, the said motor vehicle is requested to be released before the
office of the Porac Municipal Police Station in Porac, Pampanga and in
case of its release, I undertake to produce the said motor vehicle as
ordered by the court if needed as evidence in relation to the said
accident to which it is involved;
6. That, I am executing this affidavit to attest the truth of the foregoing
facts.
IN WITNESS WHEREOF, I have hereunto set my hand this 26 th day of
September, 2016 in Bulacan, Philippines.

ROBERTO D. CAYETANO, JR.

Affiant
SUBSCRIBED AND SWORN to before me this 26 th day of September,
2016, 2016 in Pampanga, Philippines.

NOTARY PUBLIC
Doc. No.
: _____;
Page No.
: _____;
Book No.
: _____;
Series of 2016.