REPUBLIC OF THE PHILIPPINES)

CITY OF LAOAG )S.S

x----------------------------------x

AFFIDAVIT OF VEHICLE DAMAGE

I, RESTY REYES CAMACAM, of legal age, married and residing at BARANGAY
CALAPACUAN, SUBIC ZAMBALES. after having been duly sworn to according to law
hereby depose and state:
1. That I am a duly-licensed driver with license # C09-94-051385 (valid
until October 15, 2027);
2. That I am the authorized driver of the motor vehicle registered under
the name of Enterprise Car Lease Phil.Inc describe as follows:
Make: TOYOTA Motor No.: PA1B13F38J4074032
Chassis No.: 1NRX385458 Body: SEDAN
PLATE No.: NDA 5123 Year Model.: 2019
3. That on July 28, 2023 at around 9:00 AM along the National Highway
Barangay Nagsanga Pasuquin, ILocos Norte, Philippines where I am
about to visit my site, I heard a sound underneath my service car
wherein a rock hit under the chassis;
4. That I am executing this affidavit in order to attest to the truth of the
foregoing circumstances and to support of the claims against the insurer
for the repair of the damage caused to said vehicle and for all legal
purposes it may serve

IN WITNESS WHEREOF, I have hereunto set my hand this 13th day of

September, 2023 at the City of Laoag.

_______________________
RESTY REYES CAMACAM
SUBSCRIBED AND SWORN to before me this 13 th day of September, 2023, at
Laoag City, Ilocos Norte and affiant exhibited a competent proof of his Identity: PDL:
C09-94-051385 Govt. Issued I.D. Valid Until October 15, 2027.
Doc. No. __________;
Page No. __________;
Book No. __________;
Series of 2023.