Republic of the Philippines)

Malaybalay City ) s.s.

AFFIDAVIT
I, ALBERTO R. LAGAMON, of legal age, married, Filipino and resident of
Bonifacio Drive, Malaybalay City, Bukidnon, after having been duly sworn to an
oath in accordance with law, depose and state:

1. That I am the driver with Non-Professional Driver’s License No. KO2-88-

037350 who drove the vehicle which met an accident sometime on October
13, 2018 in Alanib, Lantapan, Bukidnon;
2. That the subject vehicle is more particularly described as follows:

2017 NISSAN NP200 NAVARA 4X2 EL MT CALIBRE, PICK-UP, color ALPINE WHITE,
bearing Plate no. OY4289, registered to JACQUELINE JULIA A. LAGAMON with CR No.
291066370 and OR No. 1218772520;

3. That at the time of the accident, my wife Jacqueline Julia A. Lagamon

(policy holder of the vehicle insurance) is in the United States of America;
4. That I was the one who caused the hauling of the subject vehicle to Nissan
Cagayan de Oro Distributors, Inc. the soonest possible time;
5. That I was also the same person, through my brother Atty. Archibald R.
Lagamon, who submitted the photocopy of my driver’s license with
signature, police report, driver’s affidavit and pictures of damaged vehicle
within a very reasonable time to Metrobank Cagayan de Oro City
6. That I submitted the said requirements to the Metrobank and not to the
Insurance Company considering that the Metrobank is the bank where my
wife loaned for the payment of the subject vehicle and it is the bank who
possessed the insurance policy and the original LTO Certificate of
Registration (CR) and Official Receipt (OR) of the subject vehicle;
7. That I truly made earnest effort to facilitate the early processing of the
insurance claim so that we can purchase another vehicle to replace the
totally damaged one and so that my wife will not be further troubled for the
loss;
8. That I was very lately informed and received the required official form of the
report from the insurance company. It is also necessary that the form is
signed by my wife which caused for further delay in the submission of the
said document;
9. That it was also very late that I was required to submit a detailed estimate
of the repair;
10. That whatever delay of the submission of the documents for processing of
the insurance claim was due to the above stated reasons and not in my own
making;
11. That I execute this instrument to attest the truthfulness of the foregoing
statement and for whatever legal purpose this may serve;

IN WITNESS WHEREOF, I have hereunto affix my signature this ___ day

of January 2019 in the City of Malaybalay, Province of Bukidnon, Philippines.

ALBERTO R. LAGAMON
Affiant

SUBSCRIBED AND SWORN to before me this ____ day of January 2019 at Malaybalay City,
Bukidnon. Affiant exhibited to me his proper identification and I HEREBY CERTIFY that I have personally
examined the affiant and I am satisfied that he voluntarily executed and understood this affidavit.