REPUBLIC OF THE PHILIPPINES)

PROVINCE OF LAGUNA ) S.S.

CITY OF BINAN )

AFFIDAVIT OF SELF ACCIDENT

I, EDERLINE H. MANALO, of legal age, married, Filipino citizen, and with

resident at Block 19, Lot 26, Michigan St., Town & Country Southville, City of
Binan, Laguna, after having been duly sworn to in accordance with law, hereby
depose and state:

1. That, I am the sister of EMARIE H. MANALO the owner of the vehicle

with the description below:

Model : 2020
Make : Mitsubishi
Plate No. : DAT9552
MV FILE No. : 0401-00001318496
SERIES : MONTERO SPT GLS
COLOR : Medium Red
CR No. : 40659556-0

2. That, on March 17, 2024, at around 6:00 pm, at the garage of my house,
while I was cleaning my motorcycle near in the left side of the said vehicle
I accidentally knocked the motorcycle over the side of the said vehicle;

3. As a result of the accident, the left side passenger door has been dent and
scratch ;

4. That, no one around to ask about the incident so there is no police report
to be saught;

5. That I am executing this affidavit to attest to the truthfulness and veracity

of the facts stated herein and for insurance claim purposes and other legal
purposes it will serve of the mentioned-above incident;

IN WITNESS WHEREOF, I have hereunto affixed my signature herein

below this 19thday of March 2024, at the City of Bińan, Laguna.

EDERLINE H. MANALO
Affiant

SUBSCRIBED AND SWORN TO before me this 19thday of March 2024,

exhibited to me her Passport I.D with No. P3659494B as her competent Evidence
of Identity.

WITNESS MY HAND AND SEAL on the date and at the place first above
written.

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Book No.
Series of 2024