AFFIDAVIT OF DAMAGE TO VEHICLE

I, ___________________, of legal age, Filipino, married, and a resident of

Cabangcalan, Mandaue City, Cebu, Philippines, after being sworn to in accordance with
law, depose and state:

1. That I am a duly licensed driver with Driver's License No. XOXO12345 which is valid
until 11-03-2018.

2. That on October 29, 2015 at around 10:00 A.M., after getting out from my tutorial
session at English Only Please Tutorials in Plaza Sugbo, Paseo Trinidad, Gorordo
Avenue, Cebu City, I noticed many visible surface scratches on the front bumper of my
Ford Ranger at the driver’s side near the fender, at the parking area of said plaza.