Republic of the Philippines )

______________ ) s.s.

AFFIDAVIT OF UNDERTAKING

I, _________________________, of legal age, with address at

_________________________, after having been duly sworn to in accordance with law,
hereby depose and state that;

1. I am duly appointed representative of _________________________, to

claim and retrieve a certain motor vehicle impounded with the Public Safety
Division (PSD) of the Clark Development Corporation (CDC), and registered
under his name, which is particularly described as:

Make & Type :

Motor Number :
Chasis No. :
Year Model/Color :

2. As proof of ownership of the above-described vehicle, copies of the Official

Receipt (OR) and Certificate of Registration (CR) issued by the Land
Transportation Office are hereto attached and made integral parts hereof;

3. I hereby undertake to submit all the documents within a reasonable period, or

as soon as they become available, and to pay all the necessary fees and
penalties in connection with the claim and retrieval of the above-described
vehicle;

4. I bind myself criminally, civilly and administratively liable and will assume full
responsibility for any third party claim, and hereby hold the Public Safety
Division (PSD) of the Clark Development Corporation (CDC), its employees
and officers, free from any liability arising from any claim for damages as a
result of the release of the vehicle.

5. I am executing this affidavit in order to attest to the truth of the aforesaid facts
and to justify the use of this affidavit for whatever legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ________________

at Clark Freeport Zone, Mabalacat City.

_________________________
Affiant

SUBSCRIBED AND SWORN to before me this ______________ at Clark

Freeport Zone, Mabalacat City, affiant presenting to me her Driver’s license with
#_________________________ of identity, and personally appearing before me to sign
the foregoing Affidavit of Undertaking.

Doc. No. _____

Page No. _____
Book No. _____
Series of 2019.