AFFIDAVIT OF DAMAGE TO VEHICLE

KNOW ALL MEN BY THESE PRESENTS:

I, GERRY SATONA OCLARIT, of legal age, Filipino, married to Mary
Grace P. Oclarit, and a resident of Culipat, Tarlac, after having duly sworn to in
accordance with law, depose and state:
1. That I am a duly licensed driver with Driver’s License No. C11-14-
012354 which is valid until 2022/02/22, and an owner of a private
vehicle which is more particularly described as follows:
MV FILE NUMBER 0301-00000790460
ENGINE NUMBER 4A91DL1922
MAKE/SERIES MITSUBISHI/XPANDER GLS 1.5
YEAR MODEL 2019
PLATE NUMBER CAL 9405
PLATE NUMBER (INSURANCE B3L843
DETAILS)

2. That on windy day of June 13, 2020 around 3:00pm, the above-
described car was parked within the premises of Camp Aquino, Tarlac
City when a tree suddenly collapsed on the car causing a severe
damage starting on the middle to tail part of the car. A photo of the
damages is hereto-attached for reference;
3. That I am executing this affidavit to attest to the truth the foregoing
statements and in support of the claim with the insurer for the damage
caused.
IN WITNESS WHEREOF, I have hereunto set my hands this
__________________ at Tarlac City, Philippines.

GERRY SATONA OCLARIT

Affiant

SUBSCRIBED AND SWORN to before me this _________________ at

Tarlac City, Philippines.

Doc. No. _______;

Page No._______;
Book No._______;
Series of 2020.