REPUBLIC OF THE PHILIPPINES]

CITY OF CEBU ] S.S.

AFFIDAVIT OF MOTOR VEHICLE ACCIDENT

I, Leandro Baldemor , Filipino, of legal age, married/single, a resident of Guadalupe,

Cebu City, Philippines, after having been duly sworn to in accordance with law, do hereby
depose and say that:

1. I am the owner of a 2021 Toyota Fortuner motor vehicle with the plate number LB-5000.
2. While I was traversing Fuente Osmeña Rotonda, a Ceres bus with the plate number CB-1000
hit my vehicle thereby causing damage to it.
3. I am executing this affidavit for the purpose of fulfilling the requirement of the Sterling
Insurance Company, Inc., which is to submit a sworn statement on the incident, for me to claim
insurance.

IN WITNESS WHEREOF, I have hereunto set my hand this 16th day of March, 2021 at the
City of Cebu.

_______________________
Affiant

SUBSCRIBED AND SWORN TO before me this 16th day of March, 2021 at the City of
Cebu. Affiant exhibiting to me his Passport Number 12345 issued on January 5, 2020 at DFA -
Cebu City.

Doc No. 3 ; ATTY. CARYSSA THERESE C. VERZOSA

Page No. 1 ; NOTARY PUBLIC
Book No. 2 ; Until December 31, 2022
Series 2021. Notarial Commission No. 1234
Roll of Attorney No. 43210
IBP Member No. September 25, 2019 / Cebu City
Chapter
PTR No. 1234 issued on October 16, 2019 at Cebu City
MCLE Compliance No. 12345
A.B. Oftana Bldg…, Cebu City
REPUBLIC OF THE PHILIPPINES]
CITY OF CEBU ] S.S.

AFFIDAVIT OF DESISTANCE
I, Leandro Baldemor , Filipino, of legal age, married/single, a resident of Guadalupe,
Cebu City, Philippines, after having been duly sworn to in accordance with law, do hereby
depose and say that:

1. I am the owner of a 2021 Toyota Fortuner motor vehicle with the plate number LB-5000 .
2. While I was traversing Fuente Osmeña Rotonda, a Ceres bus with the plate number CB-1000
hit my vehicle thereby causing damage to it.
3. The cost to repair my vehicle is five hundred fifty thousand pesos (Php 550,000.00). My
insurance will only cover the amount of three hundred fifty thousand pesos (Php 350,000).
4. The police report showed that the Ceres Bus was at fault during the incident.
5. The management of Ceres admitted to their liability and offered to shoulder the balance that
is not covered by my car insurance.
6. I filed a case for reckless imprudence resulting to damage to property in court.
7. I am executing this affidavit for the purpose of waiving my interest in pursuing the case,
which will be attached to the Motion to Dismiss that will be filed, on the condition that Ceres
Bus will pay me in cash.

IN WITNESS WHEREOF, I have hereunto set my hand this 16th day of March, 2021 at the
City of Cebu.

_______________________
Affiant

SUBSCRIBED AND SWORN TO before me this 16th day of March, 2021 at the City of
Cebu. Affiant exhibiting to me his Passport Number 12345 issued on January 5, 2020 at DFA -
Cebu City.

Doc No. 3 ; ATTY. CARYSSA THERESE C. VERZOSA

Page No. 1 ; NOTARY PUBLIC
Book No. 2 ; Until December 31, 2022
Series 2021. Notarial Commission No. 1234
Roll of Attorney No. 43210
 IBP Member No. September 25, 2019 / Cebu City
Chapter
PTR No. 1234 issued on October 16, 2019 at Cebu City
MCLE Compliance No. 12345
A.B. Oftana Bldg…, Cebu City
REPUBLIC OF THE PHILIPPINES]
CITY OF CEBU ] S.S.

AFFIDAVIT OF ADMISSION OF PATERNITY

I, Leandro Baldemor , Filipino, of legal age, married/single, a resident of Guadalupe,
Cebu City, Philippines, after having been duly sworn to in accordance with law, do hereby
depose and say that:

1. I am the biological father of Leana C. Baldemor whose biological mother is my common-law

partner, Edna Chu;
2. That my son/daughter, Leana C. Baldemor, was born on March 8, 2021 at Vicente Sotto
Memorial Hospital;
3. That the facts of my child’s birth were duly registered at the Office of the City Civil Registar –
Cebu City;
4. That being the father of Leana C. Baldemor, I hereby acknowledge and recognize his/her as
my child and legal heir;
5. That I am allowing my child, Leana C. Baldemor to use my surname to be his/her surname in
his/her Certificate of Live Birth; and
3. That I am executing this affidavit to attest to the truth of the above facts in compliance with
the requirement of the local civil registrar and the provisions of R.A. 9255 (An Act Allowing
Illegitimate Children to Use the Surname of Their Father).

IN WITNESS WHEREOF, I have hereunto set my hand this 16th day of March, 2021 at the
City of Cebu.

_______________________
Affiant

SUBSCRIBED AND SWORN TO before me this 16th day of March, 2021 at the City of
Cebu. Affiant exhibiting to me his Passport Number 12345 issued on January 5, 2020 at DFA -
Cebu City.

Doc No. 3 ; ATTY. CARYSSA THERESE C. VERZOSA

Page No. 1 ; NOTARY PUBLIC
Book No. 2 ; Until December 31, 2022
Series 2021. Notarial Commission No. 1234
Roll of Attorney No. 43210
IBP Member No. September 25, 2019 / Cebu City
Chapter
PTR No. 1234 issued on October 16, 2019 at Cebu City
MCLE Compliance No. 12345
A.B. Oftana Bldg…, Cebu City