REPUBLIC OF THE PHILIPPINES

CITY OF ILIGAN

AFFIDAVIT

I, MANUEL RUFINO N. BUENAFE, of legal age, Filipino, married, and a

resident of Tomas Cabili, Tominobo, Iligan City, after having duly sworn according
to law, depose and say:

That I am the owner/driver of ISUZU PICK-UP with plate no. KCR-454 and
a holder of Professional Driver’s License No. MO2-02-061847 to expire on 6-15-
2008;

That on March 30, 2008 at around more or less 11:30 AM while I was
traveling following Brgy Dalipuga, Iligan City, the front windshield of my pickup
was accidentally hit by a flying stone coming from an unknown origin;

That as a result thereof, the front windshield of my pickup was damaged;

That hence it has caused damage to my ISUZU PICK-UP;

That I attest to the foregoing facts and circumstances to support my claim

for Insurance and for whatever purpose this may serve best.

IN WITNESS WHEREOF, I hereunto set my hand this 3 rd day of April

2008, at Iligan City, Philippines.

MANUEL RUFINO N. BUENAFE

Affiant

SUBSCRIBED AND SWORN TO before me at Iligan City, Philippines, this

rd
3 day of April 2008, the affiant exhibiting to me his Community Tax Certificate
issued at Iligan City.

Doc. No. ___

Page No. ___
Book No. ___
Series of 2008