REPUBLIC OF THE PHILIPPINES)

DONE: IN THE CITY OF BAGUIO ) S.S.

AFFIDAVIT
I, IMELDA GALUT ALIBUYOG, of legal age, single, Filipino Citizen and a
resident of #47 Lower Bonifacio St., Baguio City after having been duly sworn
to in accordance with law hereby deposes and states that:

1. I am a holder of a Professional Drivers License No. N04-07-017200

issued by the Land Transportation Office (LTO), Baguio City Office;

2. I have been driving for the past TEN(10) YEARS of different motor
vehicles including top of the line SPECIAL UTILITY VEHICLES (SUV’s)
and I was never involved in vehicular accidents;

3. When I was driving a TOYOTA FORTUNER owned by ANNABEL ALANIA

GALLAZA along the downhill entrance of Lake Drive Road at Burnham
Park on December 17, 2017 at around one (1) o’clock in the afternoon, a
TAXI (a Crosswind, Isuzu Brand) suddenly crossed my path though I
applied the brake immediately the back part of the said Taxi ;hit the
front driver side of the vehicle I was driving;

4. The vehicle I was authorized to driving suffered a long deep scratch

around ten (10) inches long above the headlight and the damage part
needs replacement and repair;

5. I am executing this affidavit to attest to the veracity of my foregoing

statements and to support my CLAIM FOR INSURANCE and for all legal
intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 29 th day of

December, 2017 at Baguio City, Philippines.

IMELDA GALUT ALIBUYOG

AFFIANT
Driver’s License No.: N04-07-017200
Expires: 2019-05-01

SUBSCRIBED AND SWORN to before me this 29th day of December,

2017 at Baguio City, Philippines. Affiant personally appeared and to be the
same person who executed this instrument voluntarily.

MODESTO T. ANDONG
Notary Public
Commission No. 35-NC-16-R/Until: December 31, 2017
PTR No. 2945281/01-05-2017/Baguio City
IBP No. 1056844/01-05-2017/Baguio-Benguet Chapter
Roll No. 31289/5-15-81/Manila
Doc. No. 148; MCLE COMPLIANCE No. VI-0000192/June 14, 2016
Page No. 30; BIR TIN No. 121-017-652
Book No. XXVII; No. 19, 2nd Floor Old Market Bldg.,
Series of 2017. Magsaysay Ave., Baguio City, Philippines