REPUBLIC OF THE PHILIPPINES )

SAN PABLO CITY ) s.s.

AFFIDAVIT

I, Mae Ngat, Filipino of legal age, married and a resident of North Subd.
Brgy. 1B, San Pablo City, Philippines, after having been sworn to in accordance
with law, do hereby deposes and states THAT:

1. I am the driver of a _______ model _____________ Motor No.

_____________ Serial Chasis No. _______________ and a plate no. _______
which registered owned by Deolito Alvarez.

2. Last December 15, 2012 due to miscalculation of distance when I

was about to drive the aforesaid vehicle, the rear bumper accidentally hits
into a tree.

3. The said accident caused scratches and damages on the paint of

the rear bumper of the said vehicle as well as the front bumper.

4. I am voluntarily executing this Affidavit to attest to the veracity

of the foregoing facts and for purpose(s) of claiming property damage of said
vehicle.

IN WITNESS WHEREOF, I have hereunto affixed my signature on this 23rd

day of February 2018 at San Pablo City, Philippines.

Mae Ngat
ID#_______________
Expires on ________

SUBSCRIBED AND SWORN to before me on the date and at the place first
above written. Affiant identified through his competent proof of identity
indicated below his name and signature.

Doc No.________:
Page No._______:
Book No._______:
Series of 2018.