Republic of the Philippines )

AFFIDAVIT

I, PEDRO JUANA Filipino, of legal age, married, # 67 Farmville Subdivision Brgy. Bucal, Tanza, Cavite, after
having been duly sworn to an oath in accordance with law, do hereby depose and say:

1. That on March 30, 2017, I borrowed a motorcycle I was caught by the traffic enforcer for violation of not
wearing the prescribed helmet;

2. As a result of the said violation, I was issued a TOP No. 18173438 and my driver’s license was confiscated;

3. Through this affidavit, I hereby declare under oath that “with marital consent PEDRA JUANA (HUSBAND
OF Seller)” request such to be inserted or declared in the above said document.

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

IN WITNESS WHEREOF, I have hereto set my hand this _____ day of September , 2021 in Tanza, Cavite,
Philippines.

PEDRO JUANA
Affiant

SUBSCRIBED AND SWORN to before me this ___ day of ____________ in _______________________,

Philippines. Affiant exhibited to me her Bureau of Internal Revenue Identification with TIN number 138-438-
897-000 as competent evidence of h3r identity.

Doc No. _______;

Page No. _______;
Book No. ________;
Series of 2021