REPUBLIC OF THE PHILIPPINES )

CITY OF ILOILO ) S.S.

X------------------------X

AFFIDAVIT

That I, MARLENE N. ALVIAR, of legal age, Filipino, married and a

resident of Brgy. Gaub, Cabatuan Iloilo, Philippines, after having been duly sworn to
in accordance with law, hereby depose and say:

That I am the registered owner/ driver of a ISUZU MU-X with Plate No.
FAC1837.

That on December 12, 2019 at about 9:00 o’clock in the morning while I
was driving aforesaid vehicle in reverse direction in the garage at the residence
above mentioned, its rear tire skid upon hitting a steel gate;

That as a result thereof, the said vehicle incurred dents, scratches, damages
at the Right Rear Door and Panel;

That I did not bother to report said incident to the police station, as there was
no third persons involved neither were there injuries sustained as a result of the
said accident;

This affidavit is executed to attest to the truth of the foregoing facts and for
such other legal purpose.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

_____________ at Iloilo City, Philippines.

MARLENE N. ALVIAR

SUBSCRIBED AND SWORN to before me this ______________ at Iloilo

City, Philippines, affiant whose name and personal circumstances are herein stated,
personally appeared before me and identified by me through her Driver License No
F03-97, as competent evidence of identity, presented the foregoing document,
signed the same in my presence and affirmed, under oath, to the correctness of the
contents of the allegations thereof.

Doc. No. _______

Page No. _______
Book No. _______
Series of 2019.