REPUBLIC OF THE PHILIPPINES )

CITY OF LAOAG ) S.S.

AFFIDAVIT

I, ROBERTO Y. CHENG, of legal age, Filipino citizen, married and residents of Barrio
Nalbo (46), Ilocos Norte, under oath, do hereby depose and state that:

I am the registered owner of a motor vehicle. Machine copy of the Certificate of Registration
and Official Receipt are hereto attached for immediate reference;

I parked the aforesaid vehicle beside the Provincial Capitol of Ilocos Norte. Cconsequently, I
left my vehicle therein properly parked to run some errands;

When I returned to my vehicle after doing my errands, I discovered that the aforesaid vehicle
suffered scratches;

I am executing this affidavit to attest to the truth of the foregoing facts and for whatever lawful
and legal purpose it may serve.

SIGNED, this 12 April 2019 at Laoag City, Philippines.

ROBERTO Y. CHENG
Affiant

SUBSCRIBED AND SWORN TO before me this 12 April 2019 at Laoag City, Philippines,
with the affiants personally known to me.

ATTY. LIMBERGE PAUL G. CORPUZ

NOTARY PUBLIC
UNTIL DECEMBER 31, 2019
GEN. LUNA COR. FONACIER STS., LAOAG CITY
PTR NO. 1767300/01.04.2019/LAOAG CITY
IBP NO. 062283/01.04.2019/ILOCOS NORTE
ROLL NO. 71146
NOTARIAL COMMISSION NO. 2018-04/08-29-2018/L.C.

Doc No. 34;

Page No. 08;
Book No. IV;
Series of 2019