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    Affidavit of Undertaking - Plaza

    Uploaded by

    Jhodessy Jane Brian
    The affidavit details an accident that occurred between the affiant and another driver in January 2017. The affiant admits fault for the accident, which resulted in injuries to the other driver and passenger. The affiant undertakes to reimburse the injured parties 30,000 PHP for their medical expenses. The affiant is applying for insurance proceeds to pay this obligation, but promises to pay it personally if the insurance does not cover it. The injured parties signed a desistance affidavit only to facilitate the insurance process, not to bar legal claims if payment is not made.

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    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd

    Affidavit of Undertaking - Plaza

    Uploaded by

    Jhodessy Jane Brian
    248 views1 page
    The affidavit details an accident that occurred between the affiant and another driver in January 2017. The affiant admits fault for the accident, which resulted in injuries to the other driver and passenger. The affiant undertakes to reimburse the injured parties 30,000 PHP for their medical expenses. The affiant is applying for insurance proceeds to pay this obligation, but promises to pay it personally if the insurance does not cover it. The injured parties signed a desistance affidavit only to facilitate the insurance process, not to bar legal claims if payment is not made.

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    Undertaking

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    The affidavit details an accident that occurred between the affiant and another driver in January 2017. The affiant admits fault for the accident, which resulted in injuries to the other driver and passenger. The affiant undertakes to reimburse the injured parties 30,000 PHP for their medical expenses. The affiant is applying for insurance proceeds to pay this obligation, but promises to pay it personally if the insurance does not cover it. The injured parties signed a desistance affidavit only to facilitate the insurance process, not to bar legal claims if payment is not made.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    248 views1 page

    Affidavit of Undertaking - Plaza

    Uploaded by

    Jhodessy Jane Brian
    The affidavit details an accident that occurred between the affiant and another driver in January 2017. The affiant admits fault for the accident, which resulted in injuries to the other driver and passenger. The affiant undertakes to reimburse the injured parties 30,000 PHP for their medical expenses. The affiant is applying for insurance proceeds to pay this obligation, but promises to pay it personally if the insurance does not cover it. The injured parties signed a desistance affidavit only to facilitate the insurance process, not to bar legal claims if payment is not made.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 1

    Republic of the Philippines)

    Province of Surigao del Sur)s.s.


    Municipality of Tago . . . . .)
    X- - - - - - - - - - - - - - - - - - -/

    AFFIDAVIT OF UNDERTAKING

    I, xxxxxx, of legal age, Filipino, married and a resident of xxxxxxxxxx,


    Philippines after having been duly sworn to in accordance with law hereby depose and
    say:

    1. That on January 26, 2017, at around 7:45 o’clock in the morning, a single
    Honda XRM125, colored red, bearing plate number 71947Q, engine number
    XRM16E061982, chassis number XRM16061980, registered, owned and
    driven by xxxxxxxxx, and my single Suzuki Raider FU150SCD motorcycle,
    color black/red, bearing plate number 7944LP, engine number
    G4201D936391, chassis number BG41D116388, registered, owned and driven
    by me; both motor vehicles had figured in an accident at the National High
    Way, in front of King Cooperative Inc. building, Purok JDN, Brgy. Mabua,
    Tandag City, Surigao del Sur, which resulted to the injuries suffered by
    xxxxxxxxx and his back ride xxxxxxxxxxxxxxxx;

    3. That I admit to have been in default on the above-mentioned accident,


    therefore, I take this obligation and hereby undertake to reimbursed
    xxxxxxxxxxxxxand xxxxxxxxxxxx the amount of PhP30,000.00 as
    payment for the expenses incurred for their medication;

    4. That by reason of the accident, my motorcycle crashed and fell down in the
    pavement as well as the motor vehicle owned by xxxxxxxxxxxxxxx
    Meanwhile, I am applying for the release of the proceeds of the insurance of
    my vehicle in order to pay my obligation to xxxxxxxxxxxxxxxxxxxx;

    5. That in case of failure of my insurance company to release the proceeds of


    the insurance of my vehicle, I hereby assure and undertake to pay
    xxxxxxxxxxxxxxxxxxxxxx the amount of PhP30,000.00;

    6. That I understand that the Affidavit of Desistance they executed was


    intended only to facilitate the processing of my insurance; hence, it will not
    bar them from filing a case against me, in case of non-payment by the
    insurance company;

    7. That I am executing this affidavit to attest to the truthfulness of the


    foregoing facts and for whatever legal purpose this may serve.

    IN WITNESS WHEREOF, I have hereunto set my hand this 17 th day of March


    2017 in xxxxxxxxxxxxxxxxx Philippines.

    xxxxxxxxxxxxxxxxxxxxxxx
    Affiant

    SUBSCRIBED AND SWORN TO before me this 17th day of March 2017 at


    xxxxxxxxxxxxxxxxxxxxxxxx, Philippines.

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