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.


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_                    .