REPUBLIC OF THE PHILIPPINES )

_____________________________)S.S.

AFFIDAVIT OF DESISTANCE AND RELEASE OF CLAIM

THAT I, ELMA ___ CROBALDE, of legal age,

filipino citizen, with residence and postal
address at Zone 3, Caroyroyan, Pili,
Camarines Sur, after having been duly sworn
to in accordance with law, depose and state:

1. That I am the owner of a BLUE NISSAN

BIDA with Plate No.PRP 939, which figured in
an accident along Bgy.Tagbong, Pili,
Camarines Sur, last April 29,2020, resulting
in the damage to said motor vehicle, when it
collided with another vehicle, a RED ISUZU
ELF with Plate Number UUC-253;

2. That for and in consideration of the

payment of my demands given by the driver of
the Red Isuzu Elf Truck with Plate No.UUC-
252, Joseph F. Dacian and owner of the truck
GLORIA L. ALINDOGAN, I hereby WAIVE,
QUITCLAIM and RELEASE the owner of the truck,
Red Isuzu Elf Truck with Plate No.UUC-252 and
its driver, Joseph F. Dacian for any and all
liabilities, be it civil and/or criminal;

3. That I am voluntarily waiving all my

claims against the operator/owner of the
truck and its driver mentioned above and is
hereby executing this Affidavit of Desistance
with the full knowledge of its legal
implications;

4. That I am executing this Affidavit

of Desistance to affirm the facts and
informations alleged herein and for records
and reference purposes.
 2

IN WITNESS WHEREOF, I have hereunto set

my hand this ____ day of May, 2020, at
_________________, Philippines.

ELMA ___ CROBALDE

(Affiant)

Signed in the presence of:

_________________________ ________________

SUBSCRIBED AND SWORN TO before me this

____ day of August, 2018,
at_____________________________Philippines,
affiant exhibiting to me her Valid
Identification Card with no.___________issued
on_________________,and she acknowledge to me
that the same is her own, free and voluntary
act and deed.

DOC.NO._____;
PAGE NO.____;
BOOK NO.____;
SERIES OF 2020