Republic of the Philippines )

MUNICIPALITY OF SANTO TOMAS ) S.S.

Province of Davao del Norte )
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AFFIDAVIT OF DESISTANCE
I, PAOLO PADERNILLA RANCE, of legal age, Filipino, single and a resident of Purok 3,
Brgy. Kinamayan, Sto. Tomas, Davao del Norte, Philippines, after having been sworn to in
accordance with law, do hereby depose and say that:

1. I am the same affiant who personally and voluntarily caused the preparation and
execution of this affidavit;

2. At around 10 o’clock in the in the evening of the 1st of September, 2019, while I was about
to cross the National highway coming from Melecio Bldg., going to Seven Eleven
Convenience Store, Feeder Road #2, Brgy. Tibal-og, Sto. Tomas, Davao del Norte,
Philippines, a motor vehicle, driven by Jestoni Pampusa Paclibar, suddenly hit/bumped
unto my driven motor vehicle which resulted to a catastrophic collision. Both of us
sustained physical injuries in the different parts of our bodies and subsequently caused
damage to our driven motor vehicles;

3. After careful deliberation, I have found out that the mishap did not merit any criminal
prosecution and the injuries, damages and injuries acquired were merely accidental. In
fact, an out-of-court amicable settlement was reached between me and Jestoni Pampusa
Paclibar;

4. By virtue of this affidavit, I hereby waive my right to file any civil or criminal action in
court against Jestoni Pampusa Paclibar, his heirs and/or any person involved in the
aforesaid accident, and forever release them from any liabilities incidentally incurred
thereto;

5. I am not intimidated, forced, coerced or unduly influenced in whatever manner to execute

this joint-affidavit. Moreover, this is executed out of my own free will and volition

6. I am executing this affidavit to attest to the veracity of the foregoing declarations, to

apprise the authorities concerned and for whatever legal purpose this may serve best.

IN WITNESS WHEREOF, I have hereunto affixed my signature this September 13, 2019 at
Sto Tomas, Davao del Norte, Philippines.

PAOLO P. RANCE
Affiant
VIN: 2318-0139A-J1791PPR10000

Conformed and Signed in the Presence of:

JESTONI P. PACLIBAR

SUBSCRIBED AND SWORN to before me this September 13, 2019 at Sto. Tomas, Davao del
Norte, Philippines.

Doc No. 147;

Page No. 30;
Book No. 239;
Series of 2019.