AFFIDAVIT OF SELF-ACCIDENT

I, SOCRATES RODRIGUEZ CATIBAYAN, of legal age, married,

Filipino citizen, with postal and residence at No. B 5 L 17 Sterling
Manors, Brgy. Anabu 1-C, Imus City, Cavite, Philippines, after
being sworn in accordance with the law, do hereby depose and say:

1. That, I am a holder of Professional Driver License No. D06-

97-18527 issued by the Land Transportation Office with
validity until 09/27/2024;

2. That, I am the authorized driver of a motor vehicle

particularly described as follows:

CERTIFICATE OF REGISTRATION NO.: 287201891

Make/Type : Honda/Mobilio
Year Model : 2015
Engine No. : L15Z12102422
Plate No. : DBZ7771

3. That, on June 06, 2022, at around 12:45 P.M. the weather

during that time was fair and the road was dry. I was
driving backward the abovementioned motor vehicle to park
under the tree when inadvertently hit the branch of the said
tree.

4. That, due to the incident roof rail portion has a visible dent
that cause unestimated cost of damage.

5. I am executing this affidavit to attest to the truthfulness of

the foregoing statement and for whatever legal purpose it
may serve.

IN WITNESS WHEREOF, I have hereunto affixed my hands

this 8th day of June 2022 at Imus City, Cavite, Philippines.

SOCRATES RODRIGUEZ CATIBAYAN

Affiant

SUBSCRIBED AND SWORN to before me this 8th of June

2022 in the City of Las Piñas.
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