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Republic of the Philippines

Province of Pampanga ) S.S.

I, EDNA SUNGA, of legal age, Filipino, and resident of Barangay Bebe
Anak Escundo, Masantol, Pampanga, after having been duly sworn to in
accordance with law, depose and state:
1. That, I am the complaining witness against FRANCISCO CARREON
CALICA, driver and owner of the vehicle bearing Plate No. RJC
953 and described as Isuzu Dump Truck for injuries sustained by
our late son JORDAN SUNGA and damage to property incurred as a
result of a vehicular accident which occurred on or about 7:20 a.m.
of May 27, 2016 along Calumpit-Pulilan Road in Barangay Pungo,
Calumpit, Bulacan;
2. That, the death and damage incurred were purely accidental in
nature does not warrant a criminal prosecution;
3. That, I am not interested in prosecuting the aforementioned driver
and registered owners, either civilly or criminally;
4. That, this affidavit is executed by me of my own free will and
volition for the purpose of seeking dismissal or refraining from
further prosecution whether criminally or civilly, the aforementioned
driver and owner of the above-described vehicle and hereby waive
all present and future rights and pertaining to said incident;
5. That, the foregoing statements have been fully read by me and
translated to me in Tagalog, dialect which I speak and understand
and which are true to the best of my knowledge.
IN WITNESS WHEREOF, I have hereunto set my hand this 28 th day of
September, 2016 in Pampanga, Philippines.

SUBSCRIBED AND SWORN TO before me this 28th day of September,
2016 in Pampanga, Philippines.

Notary Public
Doc. No.
: _____
Page No.
: _____
Book No.
: _____
Series of 2016.