AFFIDAVIT

I, XYRENNE GAYLE HAYAHAY LORENZO, Filipino of legal age, with

residence at No. 21 Cantillon Street Maysan, Valenzuela City under oath, depose
and say that:

On January 2021, I was made aware by Mr. ALAIN P. DE LEON, registered

owner of [FORD] [2020 EVEREST 2.0L SP] with plate number NGA1639
(hereinafter, the “Subject Vehicle”), that he received a Notice of Violation with
Ordinance Violation Receipt (OVR) Number [OVR Number VX0058742]
(hereinafter, the “Notice”). In the said Notice, the Subject Vehicle allegedly
committed [Sec. 140 (2.b.iii) Passing through the red light] on [December 04,
2020], [01:26:11 pm] at [G Lazaro, Northbound].

On the above-stated date, time and location, I was the one driving the
Subject Vehicle.

I am responsible for any acts or omissions committed during the above-

stated date and time while driving the Subject Vehicle at the specified location.

A copy of the said Notice is attached hereto and made an integral part of
this Affidavit.

I am executing this Affidavit to attest to the truth of the foregoing

statements and for all other legal intents and purposes.

IN WITNESS WHEREOF, I have hereunto set my hand this 20th day of

October 2021 in the Malolos City, Bulacan.

XYRENNE GAYLE HAYAHAY LORENZO

[AFFIANT]

REPUBLIC OF THE PHILIPPINES)

Malolos City, Bulacan) S.S.

SUBSCRIBED AND SWORN to me before this 20th day of OCTOBER 2021,

affiant exhibited his/her UMID with No. 0111-8983412-5 issued by SSS.

Doc. No. _____ ;

Page No. _____ ;
Book No. _____ ;
Series of 2021