REPUBLIC OF THE PHILIPPINES)

CITY OF LAS PINAS ) S.S.

AFFIDAVIT OF NO INSURANCE

I, PAUL MARION T. COSTES, of legal age, Filipino, married, and with business address at JJ CARS
COMPOUND No. 148 Alabang-Zapote Road, Brgy. Almanza Uno, Las Pinas City, after having been duly
sworn to in accordance with law, depose and state that:

1. I am the General Manager of JJ CARS, INC. the registered owner of a certain registered motor
vehicle, with the particular description as follows, to wit:

MAKE: Toyota BODY: Sedan

SERIES: Vios MODEL: 2018
PLATE NO.: NBD 7310 Serial/Chassis No.:1NRX355615
MV FILE No.: 1301-00001228260

2. As such, I am the authorized representative of JJ CARS, INC. and MR. JAY DIMROSS G. MANUEL
is an authorized driver of JJ CARS, INC;
.
3. On 18 December 2022 at 10:20 AM, the said motor vehicle figured into a vehicular accident
with SinoTruch Howo A7/2018 Dump Truck bearing the plate number NEJ 2076, along
northbound lane of Roxas Boulevard near United Nations Avenue, Ermita, Manila;

4. Due to the COVID-19 Pandemic, the insurance policy of the above-mentioned motor SEDAN
vehicle was renewed belatedly.

5. I therefore have executed this Affidavit to attest the truth I mentioned herein and for whatever
legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this __th day of February 2022, in
_________________________, Philippines.

PAUL MARION T. COSTES

Affiant
LTO Driver’s License ______________________
Valid until ______________
SUBCRIBED AND SWORN TO before me this __th day of January 2022 in
__________________________ Philippines, affiant exhibiting to me her competent evidence of
identity indicated below his above- stated name.

NOTARY PUBLIC
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2022.