REPUBLIC OF THE PHILIPPINES)

CITY OF ILOILO

) S.S.

x---------------------------------------------------x

AFFIDAVIT OF UNDERTAKING

I, _________________________ of legal age, __________ Filipino and a resident of

____________________________________________________, Philippines, under oath, hereby
depose and say:

That, I am the registered owner of a motor vehicle covered by Certificate of Registration

No. ___________________ issued by LTO__________________________, more particularly
described as follows:

Make:_____________________
Type:______________________
Motor No.:__________________
Chassis No.:_________________
MV File No.:_________________
Plate No.:___________________

That, I am one and the same person_________________________________, the

registered owner of a motor vehicle, as per records with the LTO office,
_____________________________.

That, the signature which was appearing in the original Deed of Sale is true and correct
and which signature I have been using in all my legal transactions either in private or public
entity;

That, I bind myself criminally, administratively or civilly liable to any third person claim
that may arise in the future and I will assume any and all responsibility and I will not hold the
LTO personnel liable to any discrepancy;

That. I am executing this affidavit to attest to the truth of the foregoing facts in
connection with my true and correct signature as mentioned.

IN WITNESS WHEREOF, I have hereunto affixed my signature this _________day of

____________ at Iloilo City, Philippines.

_______________________
Affiant

SUBSCRIBED AND SWORN to before me this _____________ day of

_____________ affiant exhibiting to me his/her Community Tax Certificate
No.______________ issued on ________________ at _____________________.

Doc. No. _______

Page No. _______
Book No._______
Series of ________