Republic of the Philippines}

Province of Cotabato }s.s

Kidapawan City }
x-------------------------------------x

AFFIDAVIT

I, Oscar D. Bayog, of legal age, married, Filipino, a resident of Poblacion

Kidapawan City, North Cotabato, after having been duly sworn to in
accordance with law, do hereby depose and say:

That I am the designated driver of Toyota utility vehicle with Certificate

Registration No. 231041333, Engine No. IGD4086785 and Plate No. ACV1081,
owned by Dr. Araceli G. Bayog;

That while we are on are way home from Kidapawan City to Tagum City,
the upper right portion of said vehicle was sideswept by a motorcycle along the
Diversion Rood, Buhangin, Davao City, that was running very fast causing
material damages of the painted area and the nut holding the trimming was
also broken;

That we were not able to identify the Plate number of the motorcycle
and/ or the driver, for it disappeared in the crowded highway;

That I am executing affidavit to attest to the truth of the foregoing

allegations.

IN WITNESS WHEREOF, I have hereunto set my hand below this 28th day of
June 2017 at Kidapawan City, Philippines.

OSCAR D. BAYOG
Affiant
IBP ID under Roll No. 18081

SUBSCRIBED AND SWORN to before me this 28th day of June, 2017 at

Kidapawan City, Cotabato, Philippines. Affiant exhibited to his Identification
Card Number indicated below his name.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2017.