Republic of the Philippines )

City of Iligan -----------------) S.S.

x-------------------x

DRIVER’S AFFIDAVIT

I, ANECITA CHAVEZ CABAHUG, of legal age, married, Filipino,

a resident of #0016 B2 East Ros. Hgts., Tubod, Iligan City, after being
duly sworn in accordance with law, hereby depose and state that:

1. That I am a holder of a professional driver’s license with

number MO2-02-069809, and the registered owner and the driver of
Toyota Fortuner V-AT with plate number KAM-6483, more particularly,
described hereunder, to wit:

Make: Toyota
Series: 2022
Color: Pearl White
Plate No.: KAM-6483
Certificate of Registration No.: 437465674- 12/22/2021
Official Receipt No.: 2094260140 - 12/22/2022

2. That on the 4th of June 2022, while I was driving on the

Pandayan Tubod road when I reached the Merila bridge I noticed the
bride was under rrepair, and I decided to go back but my car
accidentally collided with the railings of the road, which caused
damage to the rear bumper of my car;

3. That I am executing this Affidavit to attest the truthfulness

of the foregoing facts and circumstances for vehicle insurance
purposes and for whatever legal purpose this may serve best.

IN WITNESS WHEREOF, I have hereunto set my hand this 6 th

day of June 2022 at Iligan City, Philippines.

ANECITA CHAVEZ CABAHUG

Affiant

SUBSCRIBED AND SWORN to before me, this 6th day of

June 2022 at Iligan City, Philippines. Affiant exhibited to me her
Driver License No. MO2-02-069809.

Doc. No. _____;

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