REPUBLIC OF THE PHILIPPINES)
) Ss.
AFFIDAVIT OF UNDERTAKING AS CUSTODIAN
I, , Filipino, of legal age, single/married/widow/widower, and
a resident of , after having been duly sworn to in
accordance with law, depose and state, that:
1. I am the incumbent Punong Barangay of Barangay ,
City;
2. is one of the residents of our barangay;
3. I was informed that has applied for probation having been
convicted for the crime of by the Trial Court of
, Branch _, and docketed as Criminal Case No. ;
4. I was further made to understand that desires to be released on
recognizance pending the resolution of her application for probation, and needs a
custodian for this purpose;
5. I hereby agree to be the said custodian of and undertakes to
bring him to court whenever required;
6. I am executing this affidavit to apprise all those concerned of foregoing facts and
for whatever other legal purpose it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this day of
, at , Philippines.
Affiant
SUBSCRIBED AND SWORN to before me this day of , at
, Philippines. The identity of the affiant is established by his Philippine Passport
No. _, issued on_ .
NAME OF PUBLIC ATTORNEY
Public Attorney
(Pursuant to R.A. 9406)