Republic of the Philippines.

)
Province of Bukidnon………… )S.s.
Municipality of Don Carlos…… )
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AFFIDAVIT

I, JULIET E. GO, of legal age, Filipino, married, and a resident of Purok 2, Don Carlos,
Bukidnon Philippines, after having been duly sworn to in accordance with law hereby depose
and say:

1. That I am the absolute and registered owner of a motor vehicle unit described as follows:

MAKE.: TOYOTA CS NO.: P8B894

ENGINE NO.: 1NRX585191 GROSS WEIGHT: 1550.00
DESCRIPTION: VIOS 1.3 XE CVT-EG-018 DISPLACEMENT: 1329.00 CCM
MODEL: NSP150LDEXDKM018 KEY NO.: 50185
COLOR: FREEDOM WHITE YEAR MODEL: 2020
VIN: PA1B18F33L4117644 PLATE NO. KAF 8164

2. That on or about September 6, 2020 at around 4:50 o’ clock in the afternoon, the
aforesaid motor vehicle unit sustained a considerable damage while traversing the road of
Purok 2B, Barangay Agalayan, Malaybalay City;

3. That the other vehicle is owned and operated by Murami Subic Trading Corporation;

4. That on September 6, 2020, Murami Subic Trading Corporation duly represented by

Ronald M. Rameri and myself, executed a Compromise Agreement, thereby making the
latter answer for the repairs cost of the aforesaid vehicle;

5. That unfortunately however, up to this date, and despite utmost effort to compel the
driver and his company to comply with their commitment pursuant to our Compromise
Agreement, the latter still refused and continuously refuses to pay the repair costs of the
said vehicle;

6. That I hereby attest to the truth of the foregoing circumstances to inform the proper
authorities of whatever legal purpose this affidavit may serve best.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

________________ at Don Carlos, Bukidnon, Philippines.

JULIET E. GO
Affiant
CEI: SSS ID NO. 08-1264780-0

SUBSCRIBED AND SWORN TO before me this ________________ at Don Carlos,

Bukidnon, Philippines, affiant having exhibited to me her competent evidence of identity
indicated below her name and signature.

Doc. No. ______;

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