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Affidavit

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REPUBLIC OF THE PHILIPPINES )
PROVINCE OF CAVITE ) S.S.
MUN. OF GEN. MARIANO ALVAREZ )

AFFIDAVIT ON CAR ACCIDENT

I, RODELITO VILLANUEVA MANALO, of legal age, married, and a resident of Block 41 Lot 6, Raspberry Street, Pacific Park Place Village, Dasmariñas, Cavite, after having been duly sworn in accordance with law, hereby depose and say:

1. That I am the owner of motor vehicle “2004 Toyota Vios 1.4 E/MT” with plate no. VCE225, color Red with Engine No. 2NZ-2936861 and Chassis No. MRO53HY41-09001439;

2. That the above described vehicle was being driven by me, I am a holder of Non-Professional Driver’s License #N01-97-206062 valid until 2017-05-06 issued by LTO- Dasmariñas, Cavite;

3. That today July 24, 2014 7:30am at the Parking Lot of Discovery Suit Hotel I was backing for me to park my car properly, but suddenly the Rear Left side of my Bumper bumped the post in Parking Lot resulting to damages;

4. That I understand that my vehicle as insured with Standard Insurance Co., Inc. covers damages caused by the accident as per insurance policy;

5. That I executed this Affidavit to attest to the fact of the damage sustained by my car to support my claim with the insurance company.

IN WITNESS WHEREOF, I hereunto affixed my signature this 24th day of July, 2014 at Gen. Mariano Alvarez, Cavite.

RODELITO VILLANUEVA MANALO Affiant

SUBSCRIBED AND SWORN TO before me this 24th day of July, 2014, affiant exhibited to me his Non-Professional Drivers License with No. N01-97-206062 issued on May 20, 2014 and Valid until 2017-05-06 issued by LTO-Dasmariñas, Cavite.

ILUMINADA M. VAFLOR-FABROA Notary Public Until December 31, 2014 Application No. 2012-16 12-5-12 P.T.R. No. CAV 3461381A 1-03-14 G.M.A., Cavite IBP O.R. No. 929726 1-03-14 Imus, Cavite Attorney’s Roll No. 21249 3-17-67 Congressional Ave. cor. Visayas Ave., Brgy. Maderan, GMA, Cavite

Doc. No. 1294; Page No. 92;
Book No. XIV; Series of 2014.

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