REPUBLIC OF THE PHILIPPINES )

CITY OF BATANGAS ) S.S.

AFFIDAVIT

I, JIMMY CASTILLO ARGA, of legal age, Filipino, and a resident of

Brgy. Sampaguita, Mabini, Batangas, after having been duly sworn to in
accordance with law hereby depose and state:

That I am the owner of a certain vehicle particularly described as:

2014 Ford Ranger, color C. Orange, with plate no. AAK8656;

That the said vehicle is insured by BPI/MS INSURANCE

CORPORATION under Policy No. DP777081;

That on December 3, 2019 at around 9:30 o’clock in the morning,

while the vehicle was parked at a garage in Brgy. Ilijan, Batangas City,
due to the heavy rains and strong winds caused by Typhoon Tisoy, rain
water entered the fuel tank of the above-mentioned vehicle, which
caused damages to it;

That I am executing this affidavit to attest to the truth of all the

foregoing facts, and for other legal purposes this may serve.

IN WITNESS HEREOF, I have hereunto set my hand this 10th day

of December, 2019 in Batangas City.

JIMMY CASTILLO ARGA

Affiant

SUBSCRIBED AND SWORN to before me this 10th day of

December, 2019 in Batangas City.

Doc. No. _____________

Page No. _____________
Book No. ____________
Series of _____________