REPUBLIC OF THE PHILIPPINES )

PROVINCE OF CAGAYAN ) S. S.
MUNICIPALITY OF APARRI )

AFFIDAVIT OF Vehicle damage

I, WARREN TUFFAL, of legal age, married, Filipino citizen and a resident

of Kensington Subd, Cauayan City, Isabela, after having been duly sworn to in
accordance with law, hereby depose and say:

1. I am a duly licensed driver with Driver’s License No. B02-05-060107;

2. I am an authorized driver of a TOYOTA HILUX bearing Plate No.

BAA 4745;

3. That on June 14, 2023 at around 2:00 in the afternoon , while driving
along Maharlika Highway, Isabela, a stone flew and hit the windshield
causing it to break;

4. That the incident herein stated was purely accidental resulting in

damages of the said vehicle;

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

foregoing facts and in support of claim against the insurer fir the repair
of the damage caused to said vehicle and for all legal intent and purpose
this may serve.

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

July 2023 at Aparri, Cagayan.

WARREN TUFFAL
Affiant

SUBSCRIBED AND SWORN to before me this 10th day of July 2023 at

Aparri, Cagayan

ATTY. FRANCISCO U. BULSECO,

Doc. No. _____ JR.
Page No. _____ Notary Public
Until December 31, 20
Book No. _____
Roll of Attorney No. 25108
Series of 2023. P.T.R. No. 12777828
Issued on January 3, 2023
Issued at Aparri, Cagayan