Republic of the Philippines)

Province of Southern Leyte…) S.S

Municipality of Macrohon)
DRIVER’S AFFIDAVIT

I, JORGE E. MINIAO, of legal age, Filipino, married and a resident of San Roque,
Macrohon, Southern Leyte, after having been duly sworn to in accordance with law,
do hereby depose and state;

1. That I am a duly licensed driver with Professional Driver’s License No. H03-80-
006081 which is valid until June 27, 2019;

2. That on April 23 2018, at around 9:00 am, I was driving the vehicle of my
daughter GISELLE MINIAO MINDAJAO, owned and registered in her name
which is more particularly described as follows:

Make: Ford Engine No: UEJAHB89708

Model: 2017 Chassis No: MPBSXXMXKSHB89708
Color: Candy Red Plate No./ CS No.: C0 D940
Vehicle Description: 2017 Ford Ecosport Trend

3. That while I was slowly driving along Malapok Street, San Roque, Macrohon,
Southern Leyte going to Maasin. The Barangay Road where I was driving is
still under construction and only one way lane is open, the front right side of
the vehicle got scratched by the Signage of the said road construction which
cause damage to the following parts to the said vehicle:

FRONT BUMPER ASSY

FRONT RH FENDER
FRONT RH DOOR
REAR RH DOOR

4. That upon inquiry from FAIRLANE AUTOMITIVE VENTURES INC. FORD

ORMOC located at Brgy. Bantigue, Ormoc, Leyte, the estimated cost of labor
for the Repaint of the damage is Php 24, 000.00;

5. That I am executing this affidavit to attest to the veracity of the foregoing

facts and for any legal purpose this may serve thereby;

IN WITNESS WHEREOF, we have hereunto affixed our signatures this 9 TH day of

May 2018 at Macrohon, Southern Leyte, Philippines.

JORGE E. MINIAO
AFFIANT
Driver’s License No. H03-80-006081 valid until June 27, 2019;

SUBSCRIBED AND SWORN TO before me this 9th day of May 2018 at Macrohon,
Southern Leyte, Philippines.
ATTY. MENCHIE ANN S. SALINAS
Notary Public
Com. No. 2017-10 UNTIL Dec. 31, 2018
Roll of Attorneys No. 66790
Doc. No. ____ IBP No. 021495; 1/05/18
Page No. ____ PTR No. 6073809; 1/04/18
Book No. ____ MCLE Compliance: Exempt
Series of 2018 Southern Ley