Republic of the Philippines)

Province of La Union) S.S.

City of San Fernando)
x------------x

AFFIDAVIT

I, CHRISTIAN BENEDICT R. HUFANA, Filipino, of legal age, single, and

a resident of Barangay Poro, San Fernando City, La Union, Philippines, after being
sworn to in accordance with law, depose and state:
1. 1.That I am a duly licensed driver with Driver's License No._____________,
which is valid until ___________.

2. That on December 10, 2021, at around 4:30 p.m., I was driving a motor vehicle
owned and registered in the name of uncle, GILBERT R. HUFANA which is
more particularly described as follows:
Make: ______________ Motor No.: ______________
Series: ______________ Chassis No.: ______________
Body Type: ______________ Plate No.: ______________
Year Model: ______________ MVRR No.: ______________

3. That while I was slowly backing out of the driveway to maneuver the above-
described car out of the area where it was parked at ___________, the
aforementioned vehicle suddenly hit a tree and a plant where I was backing out
and as a result the said vehicle sustained damage at its rear specifically causing
a dent at the trunk cover and breaking the left rear light.

4. That I am executing this Affidavit to attest to the truth of the forgoing and in
support of the claim against the insurer for the repair of the damage caused to
my vehicle

IN WITNESS WHEREOF, I have hereunto set my hand this December 14, 2021
in San Fernando City, La Union, Philippines.

CHRISTIAN BENEDICT R. HUFANA

Affiant

SUBSCRIBED AND SWORN TO this December 14, 2021 in San Fernando

City, La Union, Philippines.