REPUBLIC OF THE PHILIPPINES)

CITY OF DAVAO                    ) S.S.

AFFIDAVIT
 
 
        I, ________________________ of legal age, married, and a resident of Davao City,
Philippines, after having duly sworn to in accordance with law hereby depose and state:
 
1. That I am the complainant in a vehicular accident that happened on
February 6, 2020, against the respondent driver,
_______________________________ , and against the
company/owner of the truck, ______________________________

2. That the liability for the damage sustained in my vehicle was endorsed
to the company’s insurance agency
__________________________________________;

3. That it was agreed that the repair of the vehicle will be undertaken by
_______________________________;

4. That it was agreed that any parts that sustained damage due to the
vehicular accident will be replaced by new parts;

5. That I am not anymore interested to file a case against

_______________________________________;

6. That I am executing this affidavit to free the

__________________________________ from any liability that may
arise due to the vehicular accident.

Further, AFFIANT sayeth none.

 
 
        IN WITNESS WHEREOF, I hereby set my hand this 5th day of March 2020 at the City of
Davao.
 
 
 
__________________________________________
Complainant