Republic of the Philippines]

Quezon City                            ] S.S.

 
 
 
AFFIDAVIT OF DAMAGE
 
 
        I, ARMANDO ORBE, of legal age, Filipino, with address at
BLK 11, LOT 30, PHASE 4, ESTRELLA HOMES, STA. ROSA II,
MARILAO, BULACAN, after having been duly sworn to  in accordance
with law, hereby depose and declare:
 
1. That I am the husband of the registered owner of a motor
vehicle, Christine B. Orbe, more particularly described as
follows:
 
Plate:                            NBG 4603
Make:                            TOYOTA VIOS J
Chassis No.:                   PA1B13F37J4067850
Color:                            THERMALYTE
Motor No.:                     1NRX357090
C.R. No.:                       336932492
 
2. That on August 25, 2019 at around 8:00 in the evening, while
we were traversing the stretch of Aguinaldo Highway, along
Bacoor, Cavite, while we were trying to maneuver as we lost
our way, we stop in one convenient store to buy a coffee
while the passenger is trying to figure out the way to his
destination;
 
3. When we returned to the car, the passenger notice a damage
on the right passenger side of the car and called my attention
if that was existing already beforehand. I went to the side of
the car he was pertaining to and saw a damage on it.
Unfortunately, I cannot identify who caused the said damage
as I did not notice any untoward situation outside while we
were inside the convenient store;
 
 
4. We tried to ask the guard of the convenient store but
according to him he had not noticed any that hit the car. But
he only notice that the car beside the car subject hereof was
in hurry to leave, he can only identify as white Ford eco sports
car;
 
 5. I execute this affidavit to attest the truth of the foregoing
declaration, specially the damages sustained by my car while
it was unattended in a parking slot of a convenient store along
Aguinaldo Highway in Bacoor, Cavite;
 
6. I execute this affidavit to attest that the damage sustained by
the car as described above was sustained while the car was
unattended and without the fault on my part and was
sustained the same unknowingly.
 
7. That this Affidavit is executed for purposes of availing the
insurance for the repair of the damaged sustained.
 
 
 
        ARMANDO ORBE
Affiant
 
 
SUBSCRIBED and SWORN to before me this 6th day of September
2019, affiant executed her Driver’s License with No. N25-09-
001536 showing his signature and picture to attest his identity
thereof.
 
Doc. No. ____
Page No. ____
Book No. ____
Series of 2019