REPUBLIC OF THE PHILIPPINES )

CITY OF GENERAL SANTOS) S.S

AFFIDAVIT
I, GREGORY RAMOS, Filipino, of legal age, married, and a resident of
Mandaluyong 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. N05-09016206, which is valid until September 18, 2013.

That on July 29, 2013, at around 11:00 A.M., I was driving a motor
vehicle owned and registered in my name which is more
particularly described as follows:
Make:
Hyundai
Engine No.:
04PVCU289743
Series:
ACCENT HATCH 1 Chassis No.:
Body Type: HATCHBACK
Plate No.: UXQ407
Year Model: 2013`
MV
FILE
No.:
1358000098807

That while I was parking my vehicle, it came in contact with a rock

and as a result the said vehicle sustained dent and scratches in the
right side skirt of my vehicle;

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.

IN WITNESS WHEREOF, I have hereunto set my hand this August 1,

2013 in General Santos City, Philippines.
GREGORY RAMOS
AFFIANT

SUBSCRIBED AND SWORN to before me, this _____________, by the

Affiant whom I have identified through competent evidence of identity with his
Professional Drivers License No.: NO1-08-026215.