Republic of the Philippines)

City of Zamboanga )s.s.

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

AFFIDAVIT

I, JOCELYN M. RONDARIO, of legal age, married, Filipino citizen and a resident

of A4 Maharlika Drive, Talon-Talon, Zamboanga City, Philippines, after having been duly
sworn in accordance with law, hereby depose and say, that:

1. I am the registered owner of that certain motor-vehicle more particularly

described as follows;

MAKE/MODEL : MITSUBISHI MONTERO SPORT SE

YEAR : 2009
CHASSIS NO : MMBGRKH8095003349
MOTOR NO : 4M41-UCAR3647
PLATE NUMBER : VEC-752

2. Last 19 January 2010, at on or about 8:30 o’clock in the morning while I was on
my way home somewhere in Talon-Talon, this city, maneuvering the above-
described motor vehicle, I saw a delivery truck coming towards me heading from
the opposite direction;

3. As the distance of the two vehicles drew nearer, I saw that the door on the truck
driver’s side was not securely closed and was flapping as it was moving. As the
gap between the two vehicles closed to about a foot away, the door suddenly
opened with such force and hit the front left fender of the above-descried motor
vehicle, causing damage to the same;

4. As a result of the collision, the front left fender of the said vehicle was heavily
dented and bent, and the portions surrounding the fender were also damaged
and scratched;

5. I make these statements under oath and in good faith in order to establish the
fact that the damage caused were purely accidental and not due to my fault;

6. I execute this Affidavit voluntarily to attest to the truth of the foregoing facts
based on personal knowledge and authentic records in compliance with the
requirements of Pioneer Insurance Company for insurance claim.
7.
IN WITNESS WHEREOF, I have hereunto set my hand on this ___ day of
January 2010 at Zamboanga City, Philippines.

JOCELYN M. RONDARIO
Affiant

SUBSCRIBED AND SWORN to before me on this___ day of January 2010 in

the City of Zamboanga, Philippines, Affiant exhibited to me her Driver’s License bearing
numbers J04-99069527 valid until 05 January 2010 at Zamboanga City, Philippines.

MARIA FE C. GAUGANO
NOTARY PUBLIC
Zamboanga City
Until December 31, 2010
Notarial Commission No. 031-2009
Doc No._____ Door 1, 2nd Floor, LDM Bldg.,Pilar St., Zamboanga City
Page No.____ PTR No. 0207195-01/07/10
Book No. VIII IBP No. 755925-01/04/10
Series of 2010 At Zamboanga City
Roll No. 53057-04/26/07
MCLE Compliance No. III-0002962-04/07/09