Republic of the Philippines)

City of Makati ) S.S.

X--------------------------X

AFFIDAVIT

I, Jenyud J. Espejo, Filipino, of legal age, single, and resident of

147 Newfoundland Street, Better Living Subdivision, Paranaque City,
Philippines, after being sworn to in accordance with law, depose and
state:

1.That I am a duly licensed driver with Driver's License No. N03-12-

024277 covered by DLR No. 143358044, which is valid until February
1, 2023;

2. That I was driving a motor vehicle owned and registered to CIRILA

J. ESPEJO which is more particularly described as follows:

Make: Mitsubishi Motor No.:4D56UCFG0866

Series: MONTERO SPT GLX ChassisNo.:_MMBGRKG40EF014977_
Body Type: SUV Plate No.:_AAP217_
Year Model: 2014 MV File No.:_1301-00000263965_

3. That on October 12, 2018, on my way home from review at the

University of Santo Tomas, at around 1:45 AM, I had an accident;

4. That after turning to a zigzag at Swaziland Street I accidentally hit

the gate of a resident thereat and the vehicle have sustained a
damage mostly in front part of the vehicle, including but not limited to
the front bumper, windshield, front wheel, headlights, and some
scratches all over the vehicle;

4. That I am executing this Affidavit to attest to the truth of the

forgoing and in support of the claim against the insurer for the repair
of the damage caused to my vehicle;

Affiant further sayeth naught.

JENYUD J. ESPEJO

AFFIANT

SUBSCRIBED AND SWORN to before me this _____ day of _____,

2018 in the City of ______________________, herein Affiant exhibiting to
me his __________________________.

NOTARY PUBLIC

Doc. No. ____;

Page No.____;
Book No.____;
Series of 2018.
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