Republic of the Philippines )

City/Province of Cebu )S.S

AGREEMENT AND NON-PURSUANCE

This Agreement is executed and entered into by and between:

__________________________, Filipino citizen, of legal age, single and resident of Cebu, hereinafter
referred to FIRST PARTY:

- and –

_____________________________, Filipino citizen, of legal age, married and resident of Buanoy,

Balamban, Cebu, hereinafter referred to as SECOND PARTY;

1. That the FIRST PARTY is the common-law wife of ___________________ –driver of the
motorcycle Mio I 125, owned by __________________________;

2. That the SECOND PARTY is the mother of __________________________, driver of the

motorcycle Mio;

3. That on March 20, 2024 at around 8:30PM in Cebu, BOTH PARTIES involved an accident
resulting to damage to motorcycle;

4. That the SECOND PARTY will shoulder the motorcycle repair expenses of the FIRST
PARTY’s motorcycle;

5. That the FIRST PARTY will not file a case to the SECOND PARTY after this agreement and
non-pursuance will be signed;

6. That we execute this affidavit to attest to the truth of the foregoing facts as stated herein.

IN WITNESS WHEREOF, we have hereunto affixed our signatures on this ________ day of
________________ at ____________________, Philippines.

FIRST PARTY SECOND PARTY

__________________ __________________

Signed in the presence of:

______________________ and ____________________

SUBSCRIBED AND SWORN to before me this _________________________ , at

________________, Philippines, affiants showing to me their identification indicated above known to
me to be the same persons who executed the foregoing instrument and acknowledged to me that the
same is their free act and deed.

Doc. No. ________;

Book No. ________;
Page No. ________;
Series of ________.