Republic of the Philippines )

Province of Bulacan )S.S

Municipality of San Ildefonso )

AFFIDAVIT
I, BENJAMIN B. GARMA, JR., of legal age, married, Filipino Citizen, and with
residence and postal address at Barangay Bubulong Malaki, San Ildefonso, Bulacan,
after having been duly sworn to in accordance with law, do hereby declare under oath:

1. That, I am the registered owner of a motor vehicle more particularly described as

follows:

MAKE: MITSUBISHI
CHASSIS NO.: MMBGUKR10GH005927
ENGINE NO.: 4N15UAL0319
MV FILE NO.: 1301-00000687941
SERIES: MONTERO SPORT GLS

2. That, last 29 October 2017 at around 4:00pm, the said vehicle was parked
unattended along National Highway Barangay Poblacion, San Ildefonso, Bulacan
as I am attending to some personal concerns;

3. When I come back to my vehicle, I found that there are damages on the front
portion of the same more particularly on the mirror and bumper;

4. Upon inquiry on the persons within the vicinity, they could not give me any
information as to what caused the damages. There is also no cctv installed in
the area where the vehicle was parked;

5. That the foregoing statement is true and correct according to the best of my own
personal knowledge, information, and belief;

6. That I am executing this affidavit to attest to the truth of all the foregoing for
record and reference purposes and for all legal intents and purposes it may
serve.

IN WITNESS WHEREOF, I have hereunto set my hands this 28th day of January
2018 hereat San Ildefonso, Bulacan.

BENJAMIN B. GARMA, JR.

Affiant

SUBSCRIBED AND SWORN TO before me this 28th day of January 2018 hereat
San Ildefonso, Bulacan, Philippines, with the abovenamed affiant exhibiting to me her
valid identification known to me and to me known to be the person who executed the
foregoing instrument and acknowledged to me that the same is her free, voluntary act
and deed.

WITNESS MY HAND AND SEAL, on the place and date first abovewritten.

Doc. No.:______;
Page No.:______;
Book No.:______;
Series of 2018.