REPUBLIC OF THE PHILIPPINES}

CITY OF DAVAO } S.S.

AFFIDAVIT

I, LIRIO DONDOY DE VERA , of legal age, Filipino, married, and a

resident of B8 L11 Dona Carmen St., Dacoville Subdivision, Davao City,
under oath states that:

1. I own a motor vehicle, a Toyota Vios 1.5 with plate number

LGS 457;

2. On April 14, 2018, at around 2 o’clock in the afternoon, I was

driving the my car (model and make as stated above) along Panacan
Highway, when a speeding motorcycle driving its way through traffic hit
and broke my car’s right side mirror;

3. The motorcycle driver stopped because he knew he hit and

broke my side mirror, however, when I alighted from the car, the
motorcycle driver immediately sped off to avoid me and to escape his
responsibility;

4. I tried to get the plate number of the aforementioned

motorcycle, but to no avail, because the motorcycle driver was able to
snake his way through traffic;

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

foregoing statements and for all lawful intents and purposes this may
serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 17th day

of April 2018 at Davao City, Philippines.

LIRIO DONDOY DE VERA

Affiant

SUBSCRIBED AND SWORN to before me this 17th day of April 2018

at Davao City, Philippines, by affiant who exhibited to me her BIR I.D. with
TIN: 928-100-142-000 as proof of her identity, and who personally signed
the foregoing affidavit before me and acknowledged that she executed the
same.

Doc. No. ____;

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