Republic of the Philippines)

City of Davao . . . . . . . . .)s.s.

X - - - - - - - - - - - - - - - -/

DRIVERS AFFIDAVIT

I, ANA EDNA REGINALDO ALMACEN, of legal age, Filipino, married

and a resident of 2nd Blk, Fernandez Subdivision, Tacurong City, under oath
depose and say:

1. That I am the driver of that Spin Chevrolet AUV bearing Temporary

Plate No. with MV File No. 130100000512830, Chassis No.
MJBJA7580FJ1C6255, CR No. 230051754 registered in the name of
Rogelio S. Almacen;

2. That on July 20, 2016 at about 5:00 PM at our residence, I

accidentally bumped the concrete canal barrier causing scratches at
the Front Right Door and Rear Right Door of the vehicle;

3. That on or about 8:00 AM of August 8, 2016 at our residence, I

accidentally bumped the parked motorcycle causing damaged on its
front bumper;

4. That at the time the incidents happened, I am holding a valid

drivers license; That hereto attached is a copy of my drivers
license and the Certificate of Registration of the motor vehicle;

5. That I execute this affidavit purposely to attest to the truth of the

above facts and circumstances purposely in support of the
insurance claims arising out of the above mentioned incident and
for whatever legal purpose it may serve;

IN WITNESS WHEREOF, I have hereunto set my hand this September 5,

2015 at Davao City, Philippines.

ANA EDNA REGINALDO ALMACEN

Affiant

SUBSCRIBED AND SWORN to before me this September 5, 2016 at

Davao City, Philippines, personally appeared the affiant showing her Drivers
License No. M07-15-2264 as her competent proof of identity.

Doc No.___;
Page No.___;
Book No.___;
Series of 2016