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Republic of the Philippines )

City of Cagayan de Oro ) Ss.



I, ATTY. KARREN MARICRIS G. CACABELOS, Filipino, of legal age, and a

resident of SDA Compound, J. Pacana St., Cagayan de Oro City, upon my oath, do
hereby depose and state - That:

1. I am the registered owner of a Toyota Fortuner Utility Vehicle bearing Plate

number LGE-291 with Land Transportation Office (LTO) Certificate of Registration No.
6001780-1 issued on January 3, 20081.

2. Early in the evening of April 26, 2008, with due care and without negligence on
my part, I parked my car at the underground parking area of Gaisano Mall, Cagayan de
Oro City for me to purchase the week’s grocery supplies at the mall.

3. After purchasing the needed items, I headed back to the car and was shocked to
discover a deep cut on one of its doors. The cut originated from the car’s right-rear
door and extended to the adjacent rear-wheel guard, as shown by the photos herein

5. Upset over what happened, I immediately exerted diligent efforts to inquire and
search for the person responsible for the damage, but my efforts proved in vain.
Neither did anyone bother to leave a note nor did anybody identify himself and claim
responsibility for the damage caused.

6. I am executing this affidavit to attest to the truth of the foregoing facts and for
whatever legal purpose it may serve.

IN WITNESS WHEREOF, I hereunto affix my signature this August 6, 2008, at

Cagayan de Oro City, Philippines.

Copy of the LTO Certificate of Registration herein attached as Annex “A”.
Copy of the photos showing the location of the damage, herein attached as Annex “B”.
SUBSCRIBED AND SWORN to before me this August 6, 2008 at Cagayan de
Oro City, Philippines, Affiant exhibited to me her Community Tax Certificate No.
24172205 issued on January 2, 2008 at Midsayap, Cotabato. I certify that I have
examined the Affiant and I am satisfied that she had voluntarily executed the foregoing
Affidavit and that the contents thereof had been fully explained and understood by her
before she affixed her signature thereon.

Doc. No. ______

Page No. ______
Book No. ______
Series of 2008.