Republic of the Philippines )
City of _______________ ) S.S.
DEED OF UNDERTAKING
I, _____________________, Filipino, of
legal age, single/married, of _______________________, Cebu City, under oath depose and
say:
1. That I am the operator and registered owner of the _________________
public utility jeepney (PUJ) with plate number __________, which collided with the
PUJ owned and operated by ___________________ sometime on _________________, 2015 while
my vehicle was being driven on the streets, regrettably causing damage to Mr.____________’s vehicle due to the fault of my driver;
2. That I extend my sincere apologies to _____________. Accordingly, I
own primary responsibility to Mr. ______________ for the damage to his PUJ and
undertake and assure that I shall shoulder and satisfy any and all expenditures
relating to the repair of said PUJ, including but not limited to repairs;
3. That I promise to pay the amount of __________________ Pesos (PhP____________.00) to _________________ on or before ______________, 2015 in connection with my aforesaid obligation
and should I fail to pay on or before said date, the extent of my obligation on
the repairs and idleness of the vehicle to Mr. _________________ shall be _________________
Pesos (Php_______________.00);
4. I am executing this Undertaking after serious thought, without any
fraud, force, intimidation, or violence applied upon me to vitiate my consent and
with full knowledge of my rights under the law.
AFFIANT FURTHER
SAYETH NAUGHT.
(DATE), __________________, Cebu.
______________________________
ID Details: ______________
WITNESSES: _______________________ _______________________
ACKNOWLEDGMENT
BEFORE ME A NOTARY PUBLIC, for and in the City of _________,
this ______ day of ___________________, 2015 personally came and appeared ____________________, whose identity is proven by his Voter’s ID above-stated, and he
acknowledged to me that the same is his free and voluntary act and deed.
WITNESS MY HAND AND SEAL on the date
and place first above written.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2015.
