Republic of the Philippines )

Province of Pangasinan ) s.s.

Municipality of Lingayen )

AFFIDAVIT

I, LITO SANTIAGO YANQUILING, of legal age, Filipino citizen, and resident

of #10 Castillo St., Maniboc, Lingayen, Pangasinan after having been duly sworn to
in accordance with law, hereby depose and say:

1. That I am the authorized driver of a Toyota Rush with Plate Number IAD
2885, with a corresponding color of Bordeaux Mica, registered and owned by my wife
Mirriam Estrada Yanquiling;

2. That on October 31, 2022 at about 8:00 a.m., we were about to leave our
house at Duterte St., Pangapisan Sur, Lingayen, Pangasinan, and as I parked the
said vehicle on the side of our gate, my wife opened the gate, and due to the strong
wind brought about by Typhoon Paeng, the gate was rammed against the front
passenger side door;

3. That as a result of the incident, the front right passenger side door of the
said vehicle was dented while the right side view mirror incurred scratches of
undetermined value;

4. That I am executing this affidavit to attest to the truth of all the foregoing
and as a basis for my insurance claim.

Lingayen, Pangasinan, this 2nd th day of November, 2022.

LITO SANTIAGO YANQUILING

Affiant
Driver’s License No. A07-07-002473
To expire 2031/11/28.

SUBSCRIBED AND SWORN to before me this 2ND day of November 2022 at

Lingayen, Pangasinan.

Doc. No. ___ ;

Page No. ___ ;
Book No. ___ ;
Series of 2022.