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REPUBLIC OF THE PHILIPPINES) Manila City

) S.S.

AFFIDAVIT I, , Filipino, of legal age, single, and resident of, Manila, having been duly sworn in accordance with law, hereby depose and state: 1. That I am a duly licensed driver with Drivers License which is valid until the year 2015 and that I usually drive the car of my sister, , which vehicle is specifically described as a ..with Motor No. ..0 Chassis No. and with Plate No. issued by the Land Transportation Office of the City of Makati and is registered under the name of, with Official Receipt No. issued on February 26, 2013; 2. That on February 26, 2013 at around three oclock in the afternoon, when I was about to drive outside of the gate of our house, I miscalculated the driving space which caused the right side of the car to collide with the gate wall, and doing so, I got stuck in between moving the car either inside the garage gate or in the road outside so I had no choice but to drive the car back inside the garage or outside the gate and in the process, created scratches and dents in the front, right side and back sides of the car; 3. That the collision between the car and the gate wall caused a dent in the car at the front and in the bumper area; 4. That the said incident was witnessed by my father , who was the one who opened the gate as I moved the car; 5. That I am executing this Affidavit to attest to the truth of the incident as to why there are damages in the said car for its repair. IN WITNESS WHEREOF, I have hereunto set my hand this 24 th of April 2013 in Manila City, Metro Manila, Philippines. .. Affiant

SUBSCRIBED AND SWORN to before me this 24 th day of April 2013 at the Mandaluyong City. Notary Public Until December 31, 2013 PTR No. . Roll of Attys. No. ... IBP Receipt No. .

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