Republic of the Philippines)

City of Zamboanga----------)S.S.
X--------------------------------------X

DRIVER’s AFFIDAVIT

I, CLESTER N. YANGA, of legal age, Filipino and a resident of Pasonanca,

Zamboanga City, under oath, do hereby state:

1. That I am the driver of a Blue Toyota Hilux Conquest with Plate Number
KAD3477, Engine Number 2GD4714607 and Chassis Number
MR0GB8DD9K1426529 the same being registered in my name;

2. That on or about December 5, 2020, while I was driving the same vehicle inside
the parking lot of Ciudad Medical Zamboanga Hospital I accidentally hit the
concrete wall at Ciudad Medical Zamboanga parking lot resulting to damage on
the front portion of the above-described vehicle;

3. As such, I am now claiming whatever monetary claims I may have with Malayan
Insurance under policy number ____________________ expiring on
_________________;

4. That I am executing this Affidavit to attest to the truthfulness of the foregoing and
for whatever legal purpose this may serve;

IN WITNESS WHEREOF, I have hereunto set my hand this _______________ at

Zamboanga City, Philippines.

CLESTER N. YANGA
Affiant

SUBSCRIBED AND SWORN to before me this __________________ at Zamboanga

City, Philippines.

Doc. No.___
Page No.___
Book No.___
Series of 2021