REPUBLIC OF THE PHILIPPINES)

__________________________________) S.S.

AFFIDAVIT OF DAMAGE

I, ARVILLE BONDOC TACBAD, of legal age, Filipino, single, and a

resident of #51 San Miguel, Mexico, Pampanga, after being sworn in accordance
with law, hereby depose and state that –

1. I am the registered owner of one Toyota Vios with plate number

CAV2607 and covered by Car Registration No. 39371552-3 and OR No.
1928050795;

2. Said car is covered by an insurance policy with Peoples Gen

Insurance Co.;

3. On 19 October 2020, I parked near the Global City Construction

and left to attend to a personal matter. When I went back to my car, I noticed
that it sustained damages at the front left side area. I, however, was unable to
determine how it was damaged or who caused the same;

4. It is in this regard that I execute this affidavit to notify the

insurance company, Peoples Gen Insurance Co. and Toyota, and/or any office
or agency concerned for purposes of repair and/or filing of insurance claims;

5. Finally, I am executing this affidavit to attest the truth and

veracity of the foregoing statements and for all legal intents and purposes it
may serve;

6. Affiant sayeth naught.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 19 th

day of October 2020 at San Fernando, Pampanga, Philippines.

ARVILLE BONDOC TACBAD

Affiant

SUBSCRIBED AND SWORN to before me, this __________, 2020 at

City of _____________________, affiant exhibiting to me his
_________________ issued by the _______________ and valid until
__________________ bearing his photograph and signature as competent
evidence of his identity.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2020.