Republic of the Philippines

Department of Justice
National Prosecution Service
OFFICE OF THE CITY PROSECUTOR
Cagayan de Oro City

PDEA REGION __, NPS DOCKET No. X-06-INQ-17C-____

Plaintiff,

- versus - FOR: Viol. Sec. 7 and 15 of RA 9165

_______________,
Respondent.
x-------------------------------------------------x

Request for Release with Undertaking

(Of Recovered Articles by Requesting Party)

I am respectfully requesting the release to my custody of a

certain Motor Vehicle, particualarly described as follows:

MAKE : ISUZU
SERIES : DOUBLE CAB
TYPE : PICK UP
ENGINE NO. : ___________
CHASIS NO. : __________________
PLATE NO. : _______

Which was recovered by the Philippine Drug Enforcement Agency

Region __ and presently in their custody for safekeeping, and in
connection therewith, I declare under oath that:

1. I am the lawful owner and possessor thereof, as evidenced by

the OR and CR of the said vehicle and the Deed of Sale of the
said vehicle to Respondent which are hereto attached as Annex
A, B and C respectively;

2. In addition thereto, I am hereby attaching the Macro-Etching

Certificate and the PNP Motor Vehicle Clearance Certificate to
prove that the said vehicle has not been tampered with and that
the vehicle is not included in the HPG list of wanted/stolen
vehicles as Annex D and E;

3. The said vehicle is not an instrument or tool in the commission

of any offense nor proceeds thereof;
 4. I undertake to produce the said vehicle before your office or the
court when so required;

5. I affirm the statement I gave before

_______________________ on March 24, 2017 and bind
myself under penalty of law to appear and testify thereon in
court when so required.

10th day of April 2017, Cagayan de Oro City, Philippines.

_____________
Requesting Party

SUBSCRIBED AND SWORN TO before me this 10th day of

April, 2017 at Cagayan de Oro City, Philippines.

Recommending Approval:

__________________________
Investigating Prosecutor

A P P R O V E D:

___________________________
City Prosecutor