Republic of the Philippines )

MUNICIPALITY OF SANTO TOMAS ) S.S.

Province of Davao del Norte )
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JOINT-AFFIDAVIT OF DESISTANCE
WE, JASMIN PAALAN GABRIEL and MARIAFE SIBUYAN AYCO, both of legal ages, Filipinos,
married and residents of Purok 35, Km. 11, Cabantian, and Km. 11, Sasa, Davao City, Davao del Sur,
Philippines, respectively, after having been sworn to in accordance with law, do hereby depose and say that:

1. We are the same affiant who personally and voluntarily caused the preparation and execution of
this joint-affidavit;

2. At around 4 o’clock in the afternoon of the 29th day of September, 2019, while I was about to cross
the National highway coming from Feeder Road #2, in front of Darluz Marketing, Brgy. Tibal-og,
Sto. Tomas, Davao del Norte, Philippines, a motor vehicle, driven by a certain Dante Serenado,
suddenly hit/bumped us which resulted to a catastrophe. Both of us sustained physical injuries in
the different parts of our bodies and subsequently caused damage to our driven motor vehicles;

3. After careful deliberation, I have found out that the mishap did not merit any criminal prosecution
and the injuries and damages suffered were merely accidental. In fact, an out-of-court amicable
settlement was reached between our family and Dante Serenado;

4. For and in consideration of the amount of Seven Thousand Pesos only Philippine currency (Php.
7,000.00), of which Two Thousand Pesos (Php.2,000.00) shall be delivered unto us upon execution
of this instrument, and the balance of Five Thousand Pesos (Php.5,000.00) shall likewise be
delivered unto us on or before the 14th day of October, 2019. After complying such, we then hereby
relieve and discharge Dante Serenado, his heirs and assigns, from any and all claims and interests,
damages and/or whatever claims due and by reason of the said accident and thereby waive our
right to file any civil or criminal action in court against the aforementioned person and/or any
person/s involved in the aforesaid accident and therefore forever release him from any liabilities
incidentally incurred thereto upon satisfaction of such term;

5. We are not intimidated, forced, coerced or unduly influenced in whatever manner to execute this
joint-affidavit. Moreover, this is executed out of our own free will and volition;

6. We are executing this joint-affidavit to attest to the veracity of the foregoing declarations, to apprise
the authorities concerned and for whatever legal purpose this may serve best.

IN WITNESS WHEREOF, we have hereunto affixed our signatures this October 11, 2019 at Sto.
Tomas, Davao del Norte, Philippines.

JASMIN P. GABRIEL MARIAFE S. AYCO

Affiant Affiant
TIN: 729-077-284-000 PhilHealth ID No. 02-026509919-0

Conformed and Signed in the Presence of:

DANTE SERENADO

SUBSCRIBED AND SWORN to before me this October 11, 2019 at Sto. Tomas, Davao del Norte,
Philippines.

Doc No. 161;

Page No. 33;
Book No. 240;
Series of 2019.