Republic of the Philippines}

City of Davao } S.S

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AFFIDAVIT OF CAR ACCIDENT

I, GENER PERLA CAALIM, of legal age, married, Filipino and resident

of El Rio Vista B10-L19-21 Davao City, after having been duly sworn to in
accordance with law, hereby depose and say that;

1. That I am the registered owner of motor vehicle described below;

Chassis Number : MHYZE81SXKJ301116

Engine No : K14BT1282954
Body Type : WAGON
Make : SUKUZI
Plate No. :
Model Year : 2018

2. That on April 10, 2018 at about 12:15 midnight I was driving way back
home and about to park my car and suddenly hit my fence and it causes
damage in the right passenger seat door. I also had an incident in Digos City
last June 23 of the same year; I was on the road when suddenly hit a dog
unexpectedly crossed the street and made some cracks in my car’s bumper.
Lastly, this 8th of September, I assume someone made some scratches in the
left passenger side of my car.

3. I am executing this affidavit to attest the truthfulness of the foregoing facts

and for whatever legal purposes it may serve.

IN WITNESS WHEREOF, We have hereunto affixed my signature this

September 20, 2019 in the City of Davao Philippines.

GENER PERLA CAALIM

Affiant

SUBSCRIBED AND SWORN to before me this September 20, 2019 in the

City of Davao. Affiant personally appeared and showing to me his Driver’s
License No.L03-96-027531

Doc No.386;
Page No.78;
Book No.59;
Series of 2019