I, Name of mother and/or other proposed custodian of the child, of legal age, married, with residence and postal address at ____________________________, Manila, after being duly sworn to in accordance with law, hereby depose and say:
- I am the mother/father of Name of child, 15 years old, who is charged with Viol. of PD 1619 before the City of Manila, Regional Trial Court (Br. 43);
- The above named child is under my custody and care at the time of his arrest allegedly for the said offense;
- I am ready and willing to assume and fulfill my duty and responsibility to supervise and guide the said child during his release on recognizance pursuant to the provisions of the Child and Youth Welfare Code and the Family Courts Act of 1997;
- I am likewise solemnly promising and undertaking before this Honorable Court to produce and present the said child before this Honorable Court whenever required to do so during the pendency of the above-cited case in order to answer for the said charge.
WHEREFORE, in order to attest to the truth of the foregoing, I am hereby affixing my signature to this Affidavit of Undertaking this ______ day of _________, 20____ in _________.
(Sgd.) Name of mother and/or proposed custodian