REPUBLIC OF THE PHILIPPINES )

CABANATUAN CITY )S.S.

AFFIDAVIT

I, JEREMIAS G. GARCIA, JR., of legal age, Filipino and a resident of

Baloc, Sto. Domingo, Nueva Ecija after having been sworn to in
accordance with law, hereby state the following:

1. That I am the owner of a vehicle with description as follows;

Plate No. : RMM455

MV File: 0332 00000197249
Engine No. 1NZY673018
Chassis No. MR054HY9104090332
Make : Toyota
Type of Body: Hatchback

2. That on January 20, 2014 at about 6:30 PM, while I was driving my
said vehicle along the National Highway in Brgy. Parista, Lupao,
Nueva Ecija the said vehicle was suddenly bumped by a tricycle but
the driver of the said tricycle did not stop and escaped, and
eventually caused dents to the right side, upper and lower side of
the vehicle and incurred damages thereon. I did not chase the
tricycle driver as I am afraid, it might only be a ploy to hold-up me
if I follow it to a small and dark alley where it went;

3. That I am now executing this affidavit to attest to the truthfulness of

this fact and to support my insurance claim for the repair of said car
and for other legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my signature this ____ day of

__________________, 2013 at Cabanatuan City.

JEREMIAS G. GARCIA, JR
Affiant

SUBSCRIBED AND SWORN to before me at the place and date above

stated. I hereby certify that I personally examined the affiant and am
convinced that he voluntarily executed the foregoing affidavit, read the
same and understood its contents.

WITNESS MY HAND AND NOTARIAL SEAL.

REPUBLIC OF THE PHILIPPINES )
CABANATUAN CITY )
AFFIDAVIT
I, ANGELO BALAGTAS GUEVARRA, of legal age, single, Filipino and a resident of
Sapang, Jaen, Nueva Ecija after having been sworn to in accordance with law, hereby state the
following:
4. That I am the authorized driver of a vehicle, owned by my Father, GERRY Q.
GUEVARRA with description as follows;
Plate No. :____________________
MV File: ____________________
Engine No. ___________________
Chassis No. ___________________
Make : _______________________
Type of Body: _________________
5. That on July 1, 2013 at about 5:00 PM, while I was driving the above described vehicle
along the Street of Brgy. Dicarma, Cabanatuan City, the said vehicle was accidentally
bumped by another vehicle being driven by the certain Jeremias C. Garcia while he was
maneuvering his vehicle backwards from his office, and eventually caused dents to the
rear bumper of vehicle and incurred damages thereon;

6. That I am now executing this affidavit to attest to the truthfulness of this fact and for
other legal purposes it may serve.
IN WITNESS WHEREOF, I have hereunto set my signature this ____ day of
__________________, 2013 at Cabanatuan City.

ANGELO BALAGTAS GUEVARRA

Affiant
Drivers License No. C05-13-000771
Expiry date 2015-09-02
SUBSCRIBED AND SWORN to before me at the place and date above stated. I hereby
certify that I personally examined the affiant and am convinced that he voluntarily executed the
foregoing affidavit, read the same and understood its contents.
WITNESS MY HAND AND NOTARIAL SEAL.

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REPUBLIC OF THE PHILIPPINES )
CABANATUAN CITY )
AFFIDAVIT
I, JEREMIAS C. GARCIA, of legal age, married, Filipino and resident of #149 Lourdes,
Sta. Rosa, Nueva Ecija, after having been sworn to in accordance with law, hereby state the
following:
1. That I am the owner of a vehicle which I bought from Ms. Jessica Ekanayake, with
description as follows;
Plate No. : RHX-797
MV File: 0332-154852
Motor No. MR18034606R
Chassis No. JDSALHAL10A45662
Make : nissan
Type of Body: Wagon
2. That on July 1, 2013 at about 5:00 PM, while I was maneuvering backwards away
from the office the above described vehicle along Maharlika Highway, Brgy. Dicarma,
Cabanatuan City, the said vehicle accidentally bumped into another vehicle being driven
by the certain Angelo B. Guevarra, and eventually caused dents to the rear bumper of
vehicle and incurred damages thereon;

3. That I am now executing this affidavit to attest to the truthfulness of this fact and to
support my insurance claim with the Insurance Company and for other legal purposes it
may serve.
IN WITNESS WHEREOF, I have hereunto set my signature this _______ day of
_________________________ at Cabanatuan City.

JEREMIAS C. GARCIA
Affiant
Drivers License No. C05-78-007225
Expiry date 2015-07-09
SUBSCRIBED AND SWORN to before me at the place and date above stated. I hereby
certify that I personally examined the affiant and am convinced that he voluntarily executed the
foregoing affidavit, read the same and understood its contents.
WITNESS MY HAND AND NOTARIAL SEAL.

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REPUBLIC OF THE PHILIPPINES )
CABANATUAN CITY )

AFFIDAVIT

I, MARK ANTHONY M. ALEJO, of legal age, Filipino and resident of 103 Gen. Tinio
Ext. Kapitan Pepe (Pob.), Cabanatuan City, after having been sworn to in accordance with law,
hereby state the following:

7. That I am the owner of a vehicle, with description as follows;

Plate No. : TOK575

MV File: 1384-00000292447
Engine No. 2KD6990588
Chassis No. KUN405081848
Make : Toyota Innova
Type of Body: WAGON

8. That on May 27, 2013 at about 9:00 in the evening, while I was driving along the road at
NFA, Maharlika Highway, Cabanatuan City, Nueva Ecija, the said vehicle accidentally
bumped into a dog and eventually caused the vehicle to incur damages on its front
bumper and left fender liner (or in the side of the drivers seat);

9. That I am now executing this affidavit to attest to the truthfulness of this fact and to
support my insurance claim with the Insurance Company and for other legal purposes it
may serve.
IN WITNESS WHEREOF, I have hereunto set my signature this _____ day of
___________________________ at Cabanatuan City.

MARK ANTHONY M. ALEJO

Affiant
Drivers License No. 05-98-109463

SUBSCRIBED AND SWORN to before me at the place and date above stated. I hereby
certify that I personally examined the affiant and am convinced that he voluntarily executed the
foregoing affidavit, read the same and understood its contents.
WITNESS MY HAND AND NOTARIAL SEAL.

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REPUBLIC OF THE PHILIPPINES )
CABANATUAN CITY )

AFFIDAVIT

I, NOEL FRANCISCO NICOLAS, of legal age, Filipino and resident of 38 Manuel avenue,
Kapitan Pepe, Subd., Cabanatuan City, after having been sworn to in accordance with law,
hereby and state the following:

1. That I am the authorized driver of a vehicle owned by my sister, Mrs. Nelya N. Cleto,
with Car Registration No. 60876347 more particularly described as follows;
MV File No. : 1366-53826
Engine No. : P6FDI-P430111
Chassis No. : PADEK1540XV103086
2. That on February 2, 2012 while I am maneuvering the said vehicle backwards from our
garage, I accidentally hit the gate and caused a material damage on the front left side
bumper and left side front door;
3. That on February 4, 2012, I went to NE Pacific Mall, Cabanatuan City and at about 4:00
PM I parked and left unattended the said above described vehicle;
4. That when I went back to the parking place where I parked the said vehicle I noticed
that the Right hand panel, rear bumper and trucklid panel already incurred dents and
material damages thereon;

5. That when I inquired from the security guard on duty who could have caused dents and
material damages thereon, the security guard could not give a definite answer because
the post of security guard was very far away from my parked vehicle and he could not
have seen it;

6. That I am now executing this affidavit to attest to the truthfulness of this fact and to
support my sisters insurance claim with Standard Insurance Company Inc. and for other
legal purposes it may serve.
IN WITNESS WHEREOF, I have hereunto set my signature this 2nd day of March, 2012 at
Cabanatuan City.

NOEL FRANCISCO NICOLAS

Affiant
Drivers License No. C05-81-014047
SUBSCRIBED AND SWORN to before me at the place and date above stated. I hereby
certify that I personally examined the affiant and am convinced that he voluntarily executed the
foregoing affidavit, read the same and understood its contents.
WITNESS MY HAND AND NOTARIAL SEAL.
REPUBLIC OF THE PHILIPPINES )
CABANATUAN CITY )

AFFIDAVIT

I, NEIL ALDWIN MARTIN RIVERA, of legal age, Filipino and resident of 081 San Ricardo,
Talavera, Nueva Ecija, after having been sworn to in accordance with law, hereby and state the
following:

7. That I am the authorized driver of a vehicle owned by my mother, ANALIZA MARTIN

RIVERA, with Car Registration No. 11451977-5 more particularly described as
follows;
MV File No. : 1340-00000447065
Engine No. : 2KD5096496
Chassis No. : MR0ZR69G100101128
Body Type : SUV

8. That on January 3, 2012, I went to NE Pacific Mall, Cabanatuan City and at about 4:00
PM I parked and left unattended the said above described vehicle;
9. That when I went back to the parking place where I parked the said vehicle I noticed
that the Right hand quarter panel cladding already incurred dents and material damages
thereon;

10. That when I inquired from the security guard on duty who could have caused dents and
material damages thereon, the security guard could not give a definite answer because
the post of security guard was very far away from my parked vehicle and he could not
have seen it;

11. That I am now executing this affidavit to attest to the truthfulness of this fact and to
support my mothers insurance claim with Standard Insurance Company Inc. and for
other legal purposes it may serve.
IN WITNESS WHEREOF, I have hereunto set my signature this 9 th day of January, 2012 at
Cabanatuan City.

NEIL ALDWIN MARTIN RIVERA

Affiant
Drivers License No. C05-10-0086-48
SUBSCRIBED AND SWORN to before me at the place and date above stated. I hereby
certify that I personally examined the affiant and am convinced that he voluntarily executed the
foregoing affidavit, read the same and understood its contents.
 WITNESS MY HAND AND NOTARIAL SEAL.

REPUBLIC OF THE PHILIPPINES )

CABANATUAN CITY )
AFFIDAVIT
I, JOSEPHINE Q. LACSON, of legal age, married, Filipino and resident of Lorenville
Magsaysay Sur, Cabanatuan City, after having been sworn to in accordance with law, hereby
state the following:
10. That I am the authorized driver of a vehicle owned by my sister-in-law, VENUS
CATACUTAN, with description as follows;
Plate No. : RGD-389
MV File: 0388-00000145177
Engine No. 1NZ-X698391
Chassis No. NCP93-8002141
Make : Toyota
Type of Body: Sedan
11. That on December 2, 2011 at about 4:30 PM, while Im maneuvering the above described
vehicle along the Street of Mabini Homesite, Cabanatuan City, the said vehicle
accidentally bumped into a concrete wall of a building opposite to my water refilling
station, and eventually caused dents to the rear bumper and trunklid panel of vehicle and
incurred material damages thereon;
12. That I left unattended the said vehicle to seek help and unfortunately when I came back
the day after the said incident I noticed that there were already scratches on the
following:
Engine Hood Panel;
Front bumper;
Left and Right hand Front door panel;
Left and Right hand door panel;
Left and Right hand fender panel; and
Left and Right hand quarter panel

13. That I am now executing this affidavit to attest to the truthfulness of this fact and to
support my sister-in-law, VENUS CATACUTAN, insurance claim with the Insurance
Company and for other legal purposes it may serve.
IN WITNESS WHEREOF, I have hereunto set my signature this 4th day of January, 2012 at
Cabanatuan City.

JOSEPHINE Q. LACSON
Affiant
 Drivers License No. C05-08-003133
Expiry date 2013-05-06
SUBSCRIBED AND SWORN to before me at the place and date above stated. I hereby
certify that I personally examined the affiant and am convinced that he voluntarily executed the
foregoing affidavit, read the same and understood its contents.
WITNESS MY HAND AND NOTARIAL SEAL.

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REPUBLIC OF THE PHILIPPINES )

CABANATUAN CITY )

AFFIDAVIT

I, ROMMEL B. LUGOD, of legal age, married, Filipino and resident of San Josef Sur,
Cabanatuan City, after having been sworn to in accordance with law, hereby state the following:

14. That I am the authorized driver of a vehicle owned by my auntie, Pastora Rosale, with
description as follows;

Plate No. : XMH-467

MV File: 1340-00000428457
Engine No. L13A31801975
Chassis No. MRGHD65703P020245
Make : Honda City PD2 1.3 S M/T
Type of Body: 4-D-Sedan

15. That today, around on November 13, 2011 at about 5:00 PM, while Im driving along the
road at Zaragoza, Nueva Ecija, the said vehicle accidentally bumped into a hard steel and
eventually caused the vehicle to be immobilized and incurred material damages thereon;

16. That I am now executing this affidavit to attest to the truthfulness of this fact and to
support my aunties insurance claim with the Insurance Company and for other legal
purposes it may serve.
IN WITNESS WHEREOF, I have hereunto set my signature this 15 th day of November, 2011
at Cabanatuan City.
 ROMMEL B. LUGOD
Affiant
Drivers License No. C05-92-055147
Expiry date 09-12-2012
SUBSCRIBED AND SWORN to before me at the place and date above stated. I hereby
certify that I personally examined the affiant and am convinced that he voluntarily executed the
foregoing affidavit, read the same and understood its contents.
WITNESS MY HAND AND NOTARIAL SEAL.

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FRONT WINDSHIELD DEBRIE HOOD RIGHT FENDER

REPUBLIC OF THE PHILIPPINES )

CABANATUAN CITY )

AFFIDAVIT

I, MELANIE C. GARCIA, of legal age, married, Filipino and resident of Brgy. Rizal, San
Leonardo, Nueva Ecija, after having been sworn to in accordance with law, hereby state the
following:

1. That I am the authorized driver of a vehicle owned by my husband Rodel S. Garcia with
Car Registration No. 9979148-4 and more particularly described as follows;

MV File: 1340-00000428457
Plate no.: NQZ 312
Engine No. 2KD6458412
Chassis No. KUN405034850

2. That on November 1, 2011 at about 6:30 PM, I went to Brgy. Rizal, San Leonardo Nueva
Ecija Cemetery, San Leonardo Nueva Ecija, and I parked and left unattended the said
vehicle;

3. That when I came back to the parking place where I parked said vehicle I noticed that the
rear bumper already incurred dents and material damages thereon;

4. That I am now executing this affidavit to attest to the truthfulness of this fact and to
support my insurance claim with the Insurance Company and for other legal purposes it
may serve.
IN WITNESS WHEREOF, I have hereunto set my signature this 11th day of November, 2011
at Cabanatuan City.
 MELANIE C. GARCIA
Affiant
Drivers License No. C05-06-003336
Expiry date March 6, 2012
SUBSCRIBED AND SWORN to before me at the place and date above stated. I hereby
certify that I personally examined the affiant and am convinced that she voluntarily executed the
foregoing affidavit, read the same and understood its contents.
WITNESS MY HAND AND NOTARIAL SEAL.

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REPUBLIC OF THE PHILIPPINES )

CABANATUAN CITY )

AFFIDAVIT

I, EDUARDO C. GUILLASPER, of legal age, married, Filipino and resident of 392

Purok 1 Mabini Homesite, Cabanatuan City, after having been sworn to in accordance with law,
hereby state the following:

5. That I am the authorized driver of a vehicle owned by my wife Zenaida R. Guillasper

with Car Registration No. 13012269-4 and more particularly described as follows;

MV File: 0332-00000180389
Plate no.: RLF 489
Engine No. 2KD6835520
Chassis No. KUN405049493
Body type: Wagon

6. That on October 17, 2011, I went to Nueva Ecija Science and Technology (NEUST),
where I work as faculty, and I parked and left unattended the said vehicle:

7. That when I went back to the parking place where I parked said vehicle at about 9:27 PM
I noticed that the front part bumper already incurred dents and material damages thereon,
and consequently reported said incident to the NEUST guard, as per attached NEUST
guards blotter marked herein as Annex A ;

8. That I am now executing this affidavit to attest to the truthfulness of this fact and to
support my insurance claim with the Insurance Company and for other legal purposes it
may serve.
 IN WITNESS WHEREOF, I have hereunto set my signature this ____ th day of
___________, 2011 at Cabanatuan City.

EDUARDO C. GUILLASPER
Affiant
Drivers License No. C05-70-056334
SUBSCRIBED AND SWORN to before me at the place and date above stated. I hereby
certify that I personally examined the affiant and am convinced that he voluntarily executed the
foregoing affidavit, read the same and understood its contents.
WITNESS MY HAND AND NOTARIAL SEAL.

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REPUBLIC OF THE PHILIPPINES )

CABANATUAN CITY )

AFFIDAVIT

I, ELMER V. GARCIA, of legal age, married, Filipino and resident of 205 Sampaguita
Magsaysay South, Cabanatuan City, after having been sworn to in accordance with law, hereby
and state the following:

1. That I am the owner of a vehicle with Car Registration No. 12449349-3;

2. That on September 13, 2011, I went to Megacenter, Melencio St., San Roque Dist.,
Cabanatuan City and at about 3:00 PM I parked and left unattended the said vehicle
described as follows: :
CR No. 12449349-3
MV File: 1340-00000460348
Plate no.: PQW175
Engine No.G4HGAP041721
Chassis No. KNABK513BT077426
Body type : HATCHBACK
3. That when I went back to the parking place where I parked said vehicle I noticed that the
left part of the rear bumper already incurred dents and material damages thereon;

4. That I am now executing this affidavit to attest to the truthfulness of this fact and to
support my insurance claim with the Prudential Guarantee and Assurance, Inc. and for
other legal purposes it may serve.
 IN WITNESS WHEREOF, I have hereunto set my signature this 30th day of September,
2011 at Cabanatuan City.

ELMER V. GARCIA
Affiant
Drivers License No. ___________
SUBSCRIBED AND SWORN to before me at the place and date above stated. I hereby
certify that I personally examined the affiant and am convinced that he voluntarily executed the
foregoing affidavit, read the same and understood its contents.
WITNESS MY HAND AND NOTARIAL SEAL.

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REPUBLIC OF THE PHILIPPINES )

CABANATUAN CITY )

AFFIDAVIT

I, ANTONIO D. TIGLAO, of legal age, married, Filipino and resident of Imperial Homes
Subd., Cabanatuan City, after having been sworn to in accordance with law, hereby and state the
following:

1. That I am the owner of a vehicle with Car Registration No. 11450526-3;

2. That on July 15, 2011, I went to Wesleyan University-Philippines and at about 8:00 PM I
parked and left unattended the said vehicle described as follows: :
CR No. 11450526-3
MV File: 1340-0000000000446137
Plate no.: PAQ860
Engine No. 2KD6596207
Chassis No. KUN405040320
Body type : Wagon
3. That when I went back to the parking place where I parked said vehicle I noticed that
the middle part of the rear bumper already incurred dents and material damages thereon;

4. That I am now executing this affidavit to attest to the truthfulness of this fact and to
support my insurance claim with the Mercantile Co. Inc. Insurance and for other legal
purposes it may serve.
IN WITNESS WHEREOF, I have hereunto set my signature this 8 th day of August, 2011 at
Cabanatuan City.
 ANTONIO D. TIGLAO
Affiant
Drivers License No. C05-01-012094
SUBSCRIBED AND SWORN to before me at the place and date above stated. I hereby
certify that I personally examined the affiant and am convinced that he voluntarily executed the
foregoing affidavit, read the same and understood its contents.
WITNESS MY HAND AND NOTARIAL SEAL.

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REPUBLIC OF THE PHILIPPINES )

CABANATUAN CITY )

AFFIDAVIT

I, JOHN JOSEPH PONCE ENRIQUEZ, of legal age, single, Filipino and resident of St.
Francis, Kapitan Pepe, Cabanatuan City, after having been sworn to in accordance with law,
hereby and state the following:

12. That I am the driver of my fathers, Mariano G. Enriquez Jr., vehicle with Car
Registration No. 9496623-3;
13. That on April 23, 2011, I went to NE Pacific Mall, Cabanatuan City and at about 4:00
PM I parked and left unattended the said vehicle described as follows: :
CR No. 9496623-3
MV File: 1340-00000421933
Plate no.: MGE 99
Engine No. 2KD7844600
Chassis No. MROER39G507502167
Body type : Pick Up Model 2010
14. That when I went back to the parking place where I parked said vehicle I noticed that
the middle part of the rear bumper already incurred dents and material damages thereon;

15. That when I inquired from the security guard on duty who could have caused dents and
material damages thereon, the security guard could not give a definite answer because
the post of security guard was very far away from my parked vehicle and he could not
have seen it;
 16. That I am now executing this affidavit to attest to the truthfulness of this fact and to
support for my fathers insurance claim with the Peoples General insurance and for
other legal purposes it may serve.
IN WITNESS WHEREOF, I have hereunto set my signature this 4 th day of May, 2011 at
Cabanatuan City.

JOHN JOSEPH P. ENRIQUEZ

Affiant
Drivers License No. C05-07-001420
SUBSCRIBED AND SWORN to before me at the place and date above stated. I hereby
certify that I personally examined the affiant and am convinced that he voluntarily executed the
foregoing affidavit, read the same and understood its contents.
WITNESS MY HAND AND NOTARIAL SEAL.

REPUBLIC OF THE PHILIPPINES )

CABANATUAN CITY )

AFFIDAVIT

I, GENER S. SUBIA, of legal age, single, Filipino and resident of Lapaz, Tarlac, after
having been sworn to in accordance with law, hereby and state the following:
1. That I am the owner of a vehicle with Car registration No. 10999205-0;

2. That the said vehicle is described as follows:

CR No. 10999205-0
MV File: 38-269430
Plate no.: L-PCQ-570
Engine No.
Chassis No. 6692738-3
Toyota Yaris Model 2010
3. That on February 5, 2011, about 8:30 AM while I am maneuvering backward the said
vehicle to get outside from our garage, I accidentally hit the concrete post of the fence
of our house in Lapaz, Tarlac and eventually caused material damage on the back side
and the right side thereof;

4. That I am now executing this affidavit to attest to the truthfulness of this fact and to
support for my vehicle insurance claim with the Mercantile Insurance Company and for
any other purposes it may serve.
 IN WITNESS WHEREOF, I have hereunto set my signature this 21st day of February, 2011
at Cabanatuan City.

GENER S. SUBIA
Affiant
Drivers License No. C11-07-009226
SUBSCRIBED AND SWORN to before me at the place and date above stated. I hereby
certify that I personally examined the affiant and am convinced that he voluntarily executed the
foregoing affidavit, read the same and understood its contents.
WITNESS MY HAND AND NOTARIAL SEAL.

REPUBLIC OF THE PHILIPPINES )

CABANATUAN CITY )

JOINT AFFIDAVIT

We, RONALDO J. NUNEZ, owner of a truck described below, and ALBERT E. ABAD,
a truck driver described below, both of legal age, married, Filipinos and residents of Purok 3,
Brgy. Obrero, Cabanatuan City, Nueva Ecija, after having been sworn to in accordance with law,
hereby and state the following:
1. That we, RONALDO J. NUNEZ and ALBERT E. ABAD, are the owner and the driver
respectively of a truck vehicle particularly described as follows:
MV File: 1380-00000564625
Plate no.: NIY577
CR No. 10091286-2
Engine No. YZ4102ZLQB912033584
Chassis No. LVBV9JE609E101508
Series: CYCLONE
Body Type: Aluminum Van truck
2. That on August 24, 2010, about 9:00 AM, we parked and left unattended the said truck at
Sangitan Public Market, Magsaysay, District, Cabanatuan City to deliver goods such as
candies inside the said market;
 3. That when we went back to the parking place where we parked said truck we noticed that
the left side rear bumper, left side rear quarter panel body and other adjacent parts already
incurred dents, scratches, and material damages thereon;

4. That when we inquired from the people around the place who could have caused the
dents and scratches, no one could give a definite answer because everyone was busy,
hence we presumed that our truck was accidentally bumped by another vehicle also at
said place and to avoid responsibility the driver of the other vehicle sped away without
knowing what damage he caused to our truck.
5. That we are now executing this affidavit to attest to the truthfulness of this fact and to
support for our truck insurance claim with the Stronghold Insurance Co., Inc., Ayala Ave.
Makati City and for other legal purposes it may serve.
IN WITNESS WHEREOF, we have hereunto set our signature this 26 th day of October, 2010
at Cabanatuan City.

ALBERT E. ABAD RONALDO J. NUNEZ

Drivers Lic No. CO5-06-00215 Drivers Lic No. CO5-08-007503
SUBSCRIBED AND SWORN to before me at the place and date above stated. I hereby
certify that I personally examined the affiants and am convinced that they voluntarily executed
the foregoing affidavit, read the same and understood its contents.
WITNESS MY HAND AND NOTARIAL SEAL.

zREPUBLIC OF THE PHILIPPINES )

CABANATUAN CITY )

AFFIDAVIT

I, RENATO M. SAMONTE JR., of legal age, married , Filipino and resident of 116
Sapang, Jaen, Nueva Ecija, after having been sworn to in accordance with law, hereby and state
the following:
1. That I am a holder of a Deed of Absolute Sale of a vehicle from Mr. Jose M. Cuison;

2. That the said vehicle is described as follows:

MV File: 138400000163138
Plate no.: WRG464
CR No. 04446213
Engine No. TD27-669397
Chassis No. TVP4LEFE24-A23209
Series: Urvan escapade
Body Type: M Bus
3. That on February 5, 2010, about 7:30 AM while I am maneuvering backward the vehicle
to get outside from our garage, I accidentally hit the concrete post of the fence of our
house in Sapang Nueva Ecija and eventually caused material damage on the back side
thereof;
 4. That I am now executing this affidavit to attest to the truthfulness of this fact and to
support for my insurance claim of the vehicle with Standard Insurance Company and for
any other purposes it may serve.
IN WITNESS WHEREOF, I have hereunto set my signature this 8th day of February, 2010 at
Cabanatuan City.

RENATO M. SAMONTE JR
Affiant
Drivers License C05-00-004863
SUBSCRIBED AND SWORN to before me at the place and date above stated. I hereby
certify that I personally examined the affiant and am convinced that he voluntarily executed the
foregoing affidavit, read the same and understood its contents.
WITNESS MY HAND AND NOTARIAL SEAL.

REPUBLIC OF THE PHILIPPINES )

CABANATUAN CITY )

AFFIDAVIT

I, JOHN ALBERT C. MONES, of legal age, Filipino and resident of 390 Mabini
Homesite, Cabanatuan City, after having been sworn to in accordance with law, hereby state the
following:
1. That I am the driver of my mothers (Erlinda C. Mones) vehicle with plate no. ZTY 924;

2. That I am a holder of unexpired Drivers License as per attached photocopy marked

herein as Annex A;

3. That on July 12, 2010, about 6:30 AM while I am maneuvering backward the said vehicle
to get outside from our garage, I accidentally stepped the accelerator pedal instead of the
clutch or break of the vehicle and unfortunately the backside of the car hit the concrete
post of the fence of our house in 390 Mabini Homesite, Cabanatuan City and eventually
caused material damage on the back side thereof;
 4. That I am now executing this affidavit to attest to the truthfulness of this fact and to
support for my insurance claim of the vehicle with the Insurance Company and for any
other purposes it may serve.
IN WITNESS WHEREOF, I have hereunto set my signature this 12 th day of July, 2010 at
Cabanatuan City.

JOHN ALBERT C. MONES

Affiant
Drivers License ______________
SUBSCRIBED AND SWORN to before me at the place and date above stated. I hereby
certify that I personally examined the affiant and am convinced that he voluntarily executed the
foregoing affidavit, read the same and understood its contents.
WITNESS MY HAND AND NOTARIAL SEAL.