Republic of the Philippines)

City of Davao )S.S

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AFFIDAVIT

I, ROSEMARIE M. BELTRAN, Filipino, of legal age, residing at 233 Opal St.

Doña Luisa Subdivision, Phase 1, Matina, Davao City, after having been duly sworn in
accordance with law, hereby depose and say that:

1. I am the registered owner of a red Mitsubishi Montero car (“subject car” for
brevity) with plate number- LDP 3033;

2. Sometime in the last week of January, I parked the subject car inside SM
Ecoland parking area and went inside the Supermarket;

3. Hours thereafter, I went back to the parking area and to my surprise, the
subject car has dent at its rear right portion;

4. Despite due diligence and taking precaution, I could not have prevented the
same;

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

IN WITNESS WHEREOF, I hereunto affix my signature this 17 th day of March,

2020, in Davao City, Philippines.

ROSEMARIE M. BELTRAN
Affiant

SUBSCRIBED AND SWORN to before me this 17 th day of March, 2020, in Davao

City, affiant exhibiting to me her Driver’s License No. L02-13-004975 with an expiry date
December 31, 2023.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2020.