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Republic of the Philippines )

Province of Sorsogon )S.S

I, ESMERALDA EDUARTE DESDIR, of legal age, Filipino and resident of Mahingan,
Balogo, East District, Sorsogon City, Philippines, after having been duly sworn according
to law, hereby depose and say;

1. That on April 6, 2017 an incident occurred at Maharlika Highway, Brgy. Boton,

Casiguran involving a private tricycle driven by the victim and a PUJ Jitney
driven by DENNIS C. DULVA registered under the name of AURORA C. DULVA
which resulted to the death of my husband Anthony D. Desdir;

2. That the owner/operator AURORA C. DULVA offered as payment for settlement

of funeral expenses incurred and other damages caused to the family by the
death of Anthony Desdir in the amount of Two Hundred Seventy Thousand (Php
270,000.00) in Philippine Currency;

3. That said payment/settlement shall not be taken by me, our heirs, our insurer or
assigns, as a confession and/or admission of liability on the part of the said
owner/operator or by his driver in connection with the aforementioned accident;

4. That after a careful deliberation over the case, I am fully convinced that the
same arose to be purely accident causing without fault or negligence on the
part of the driver DENNIS C. DULVA;

5. That in view of the foregoing, I hereby confess, declare and manifest my

absolute lack of interest in and permanent desistance from filing any suit,
whether criminal, civil or administrative, arising out of this accidents;

6. That I have fully understood the foregoing statements which I read and
translated to me by the undersigned in our dialect.

7. That I am executing this affidavit voluntarily and free from any coercion, stealth
or strategy and to attest to the truth of the foregoing statements/facts.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ___ day of

April, 2017 at _____________, Sorsogon, Philippines.

Tin No. 700-164-591
Issued by BIR
SUBSCRIBED AND SWORN to before me this ____ day April, 2017 in
_______________, Sorsogon, Philippines by the affiant exhibiting her valid
Identification Card showing her name as proof of her identity.

Doc. No.__________
Page No.__________ NOTARY PUBLIC
Book No.__________
Series _____________