REPUBLIC OF THE PHILIPPINES)

CITY OF ILOILO ) S.S.

X - - - - - - - - - - - - - - - - - - - -- - - - X

AFFIDAVIT OF PATERNITY AND USE OF FATHER’S SURNAME

I, NADINE V. DELGADO, of legal age, Filipino, married, and a

resident of _________________________, Iloilo City, Philippines, after
having been sworn to in accordance with law, do hereby depose and say:

That I am the authorized driver of a Honda Civic Cosmic Blue AT

vehicle owned by Mario R. Villa bearing conduction sticker no. DT 9093;

That last October 31, 2017 while hastily backing towards our garage at
our house I accidentally hit the left concrete post of our gate;

That the said incident resulted to damage in the left side skirt of the car
near the back tires;

That last November 7, 2017 I went to Robinson’s Mall Iloilo City and I
parked the above – mentioned vehicle outside aforementioned mall specifically
on the side of Mabini Street;

That when I came back to my car I discovered that the lower left side of
the front bumper under the left head light of the car was damaged as if it was
hit by a another car;

That despite diligent efforts I was unable to discover the cause of the
afore – mentioned damage;

That I execute this affidavit to attest to the truth of the foregoing and/or
for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hands this

_______________________ in the City of Iloilo, Philippines.

NADINE V. DELGADO
Affiant
I.D. No. _______________________

SUBSCRIBED AND SWORN to before me this

__________________ in the City Of Iloilo

Doc. No.________
Page No. _______
Book No.________
Series of 2017