(This form will be filled up by PNP personnel with issued equipment)

Republic of Philippines)
) S.S
Mandaluyong City )

AFFIDAVIT OF UNDERTAKING

I, Mara Bianca M. Almadrones of legal age, Filipino and a resident of #41 Basilan
St. Brgy. Malamig, Mandaluyong City and presently assigned at Mandaluyong City
Police Station, after being duly sworn to in accordance with law, hereby depose and
state:

That I have issued/loaned PNP property/ies particularly described as follows:

Firearms
Kind Caliber Make Serial Issued by Status
Number
Pistol 9 mm Beretta M25831Z SAO, LSS Serviceable

Mobility
Plate Engine No. Chassis No. Color Issued by Status
No./CS No.
N/A

That I am aware that misrepresentation or falsehood will be a ground for my legal

prosecutions.

That I am executing this affidavit to attest to the truth of the forgoing data and as
an additional requirement of the NHQ inventory and Inspection Team.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed my signature

this 8Thday of February, 2018 at City of Mandaluyong Philippines.

_________________________
Affiant`s Signature

SUBSCRIBE AND SWORN to me this _____ day of _____________________at

____________________.

Doc. No. _______

Book No. _______ NOTARY PUBLIC
Page No. _______
Series of _______