AFFIDAVIT

I,PERCIVAL QUE SINDAYEN of legal age, married, Filipino with residence

and postal address at Triplet Corporation Drive, Canelar, Zamboanga City, Philippines under oath
do hereby depose and state that;

That I am the driver of a 2019 Mitsubishi Xpander, with plate number JAD5202 and registered
under the name of Gemma B. Sindayen of Aquino Drive, Canelar, Triplet, Zamboanga City.

That about 12:30 PM of October 8, 2023. As I was driving the vehicle, I was not aware of large pot holes
surrounding the road of Arcillas Beach Resort at Upper Calarian, Zamboanga City resulting to scratches
beneath the front bumper of the vehicle.

That I am executing this affidavit to attest the truth of the foregoing facts and for all legal
intents and purposes.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 16th day of October 2023 at
Zamboanga City, Philippines.

PERCIVAL QUE SINDAYEN

Affiant

SUBSCRIBED AND SWORN to before me this _________________________ at Zamboanga City

Doc. No.
Page No.
Book No.
Series of 2023