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Republic of the Philippines) S.S.

City of Cagayan de Oro)


x--------------x

AFFIDAVIT OF DAMAGE TO VEHICLE

I, JOEY T. CABURATAN, Filipino, 62 years old, married, and a


resident of Bliss Site, Zone 8, Macanhan, Carmen, Cagayan de Oro City,
Philippines, after being duly sworn to in accordance with law, hereby
depose and state:

1. That I am a duly licensed driver with Professional Driver's


License No. K02-76-040819 issued by the LTO of Cagayan de Oro City;

2. That I am presently a SACRISTAN MAYOR/Driver of FR. DANIEL


D. CORONEL, ADMINISTRATOR of St. Joseph chapel at Macanhan,
Cagayan de Oro City;

3. That on 14 July 2018 at around 10:40 in the evening, I was


driving a vehicle, owned and registered in the name of FR. DANIEL D.
CORONEL which is more particularly described as follows:

Make: TOYOTA VIOS Engine No.: L13Z1-1400806


Model: 2006 Body Type: SEDAN
Color: BEIGE/METALLIC Plate No.: KDL-363
Motor No.: 1NZX494762 Serial No.: MR053HY4204209456
MV File No.: 1036-94190

4. That on the right side of the road going to the Rectory, there was
a concrete drainage and at the corner is a manhole enclosed with piles of
concrete hollow blocks protruding at the side;

5. That while traversing on the said road, and while I was


executing a right turn going to the Rectory, the vehicle I was driving hit
the said manhole/drainage protruding at the side, causing dint to the
two side doors of the car I was driving then, as can be shown by the
pictures herein attached;

6. That I am executing this Affidavit to attest to the truth of the


foregoing and in support of the claim against the insurance company for
the repair of the damaged doors of the said car as a result of the above-
mentioned incident.

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


of July 2018 at City of Cagayan de Oro, Philippines.

JOEY T. CABURATAN
Affiant

SUBSCRIBED AND SWORN to before me, this __ day of July 2018,


by JOEY T. CABURATAN who exhibited to me his driver’s license with
license number K02-76-040819.