REPUBLIC OF THE PHILIPPINES)

CITY OF ILOILO……………………) S.S.

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JOINT AFFIDAVIT OF NO INTEREST AND DESISTANCE

We, EFRAIM SOLIVIO y PAREDES, of legal age, Filipino citizen, married

and a resident of Brgy. Poblacion 3, Tigbauan, Iloilo and JOEY TAGUPA y
SELOTERIO, of legal age, Filipino citizen, married and a resident of Brgy.
Poblacion 3, Tigbauan, Iloilo after having been duly sworn to in accordance with
law, hereby voluntarily depose and say:

1. That we are victims of a vehicular accident that figured on April 25, 2021 at
around 2:57 P.M. along Brgy. San Vicente, Leganes, Iloilo as reflected in
Blotter Entry No. 2021-04-526 dated April 25, 2021 of the Blotter Book of
Leganes Municipal Police Station, which involved a White Ranger with Plate
No. ASA-1002, driven and owned by Dexter Rhick Bulan;

2. That as a result of the said accident, we sustained physical injuries

necessitating immediate treatment and medication and damaged to my
(Efraim) Honda motorcycle;

3. That we fully understand and accept that said unfortunate event was purely
accidental in nature and was not attended by negligence on the part of Dexter
Rhick Bulan;

4. That the owner of the motor vehicle, Dexter Rhick Bulan, had likewise
extended to us full satisfaction all the medical assistance that he could
provide since the time of the accident up to now to cover for the expenses
incurred owing to our treatment and medication and repair of my motorcycle
in the amount of P10,000 (for medical assistance) and P2,000.00 (repair of
my motorcycle) for Efraim Solivio y Paredes and in the amount of P15,000 for
Joey Tagupa y Seloterio;

5. That we further declare and manifest our absolute lack of interest and
permanent desistance to file any civil, criminal and/or administrative action or
otherwise, against the said Dexter Rhick Bulan from, by reason of, or in
connection with, the aforementioned vehicular accident;

6. That we also manifest that the said payment/settlement made by the driver
shall not be taken by us, our heirs, our insurer or assigns, as a confession
and/or admission of liability on her part in connection with the
aforementioned accident;

7. That we have fully read or caused to be interpreted, and understood the

contents of this affidavit, that the same reflects our true intention, and that we
are also fully aware of the legal effects of executing and signing of the same;
8. That we are executing this affidavit to attest to the truth of the foregoing.

IN WITNESS WHEREOF, we have hereunto set our hands this ____ day
of ______________ at Iloilo City, Philippines.

EFRAIM SOLIVIO y PAREDES JOEY TAGUPA y SELOTERIO

Affiant Affiant
ID: FO5-19-003069 ID: _______________

Signed in the Presence of:

___________________ ____________________

SUBSCRIBED AND SWORN to before me this ______ day of April, 2021

at Iloilo City, Philippines. Affiants exhibited to me their competent proof of
identities as above-mentioned and avows under penalty of law to the whole truth of
the contents of this instrument or document.

Doc No. ________;

Page No. _______;
Book No. _______;
Series of 2021.