Republic of the Philippines)

City of Baguio ) S.S

AFFIDAVIT OF UNDERTAKING
(Loss of Certificate of Registration and Official Receipt )

I, SAMSON B. PONTINO, of legal age, married, Filipino and a resident of Km 54

Cattubo Atok, Benguet, after being sworn to in accordance with law, hereby depose and state that:

1. I am the owner of a vehicle by virtue of Deed of Sale bearing Plate No. 1401-
0013355 of which a I was issued an OFFICIAL RECEIPT (OR) and CERIFICATE OF
REGISTRATION (CR) under my name by the Land Transportation Office (LTO). Said
OFFICIAL RECEIPT (OR) and CERGIFICATE OF REGISTRATION (CR) were safely
kept inside my envelope including other equally important documents inside our house;

2. On July 20, 2019, when I needed such document, I noticed the it was no longer in the
place where I have kept it;

3. I exerted diligent efforts to locate for the lost OFFICIAL RECEIPT (OR) and
CERTIFICATE OF REGISTRATION (CR) by looking into places where the documents might
have been placed and by inquiring as to whoever might have taken them, but unfortunately, all
my efforts were in vain. Hence, I strongly believe that said OFFICIAL RECEIPT (OR) and
CERTIFICATE OF REGISTRATION are forever lost and beyond recovery;

I have executed an affidavit of loss in relation thereto.

By way of UNDERTAKING, if the LTO- District Office, after inquiry, has found me
responsible for the unauthorized use of the herein reported lost official receipt (OR) and
CERGIFICATE OF REGISTRATION (CR), I hereby signify my conformity to meted
administrative fines and penalties due and imposed thereon, with waiver and desistance on
my part for any claim or action by reason of the said punitive measures taken against me;
and by way of warranty and undertaking if the concerned agency of the LTO, after inquiry,
will find us responsible for the authorized use of the herein reported lost Official receipt
(OR) and CERGIFICATE OF REGISTRATION (CR) . I do hereby signify my conformity
to meted administrative fines and penalties due and imposed thereon, with waiver and
measures taken against me./I shall not hold the LTO employees liable for the issuance of an
Official Registration and CERGIFICATE OF REGISTRATION (CR).

4. I am executing this affidavit of undertaking to attest to the truthfulness and veracity of

the foregoing facts and for all legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto signed this 24th day of July 2019 at
Baguio City, Philippines.

TEMPLE DOVE ROSARY D. TROTTER

Affiant

SUBSCRIBED and SWORN to before me this 24th day of July 2019 at Baguio City,
Philippines.