Republic of the Philippines)

City of Tagbilaran )SS

AFFIDAVIT OF DESISTANCE

We, JOHN VINCENT CLARETE (aka RAMBO), Filipino, of legal age, single and a resident of
Poblacion, Dauis, Bohol, Philippines, and JOY E. PENALES, Filipino, of legal age, single and a resident of
Poblacion, Dauis, Bohol, Philippines, after having been duly sworn to in accordance with law, hereby
depose and say:

1. That at around 11:30 o’clock in the evening on July 18, 2014, we were on our way to Tagbilaran
City, travelling along Dauis-Bool-Tagbilaran City road. That when were about to take our left turn
going to Tagbilaran City proper at the intersection of Bool junction, we were accidentally
bumped by a Suzuki pick-up, color white and blue and with plate no. GGF-674 registered in the
name of Christopher Aliviado with residence address at 96 Leon Kilat St., Cebu City, Philippines,
and was driven by Samuel C. Roxas, Filipino, of legal age, married and a resident of Landican,
Baclayon, Bohol, Philippines;

2. That on account of the said accident, we sustained physical injuries and were hospitalized at the
Celestino Gallares Memorial Hospital, Tagbilaran City, Philippines, from July 19, 2014 – July 29,
2014 and July 19, 2014 – August 1, 2014, respectively;

3. That the said driver, Samuel C. Roxas has duly paid all the medical expenses that we incurred on
account of the injuries sustained due to the said incident;

4. That after a thorough and careful deliberation of all the circumstances surrounding the incident,
we found out that the same does not merit or warrant any criminal and/or civil prosecution
against the owner, Christopher Aliviado and the driver, Samuel C. Roxas of the Suzuki pick-up as
the incident and injuries we suffered thereby were purely accidental;

5. That we are voluntarily executing this affidavit to signify that we are not planning nor interested
in and in fact desist, refrain and renounce the filing of nor testifying in any criminal, civil and/or
administrative action against the owner, Christopher Aliviado and the driver, Samuel C. Roxas of
the Suzuki pick-up or any other person in connection with the aforementioned incident;

6. That we have fully read and understood the foregoing statements and contents thereof and that
the same are true and correct.

IN WITNESS WHEREOF, we have hereunto set our hands this _____________________________

at the City of Tagbilaran, Philippines.

JOHN VINCENT CLARETE JOY E. PENALES

Affiant Affiant
CTC No. _______________ CTC No. __________________
Issued on ______________ Issued on _________________
Issued in _______________ Issued in __________________

Witnesses: 1. ______________________ 2. _______________________

SUBSCRIBED AND SWORN to before me this ______ day of _______________________ in the

City of Tagbilaran, Philippines, by the affiants with their Community Tax Certificates indicated below
their respective names above. I hereby certify that I have examined the herein affiant, read and
explained to them the contents of this affidavit.
That I am satisfied and convinced that they voluntarily executed the same.