REPUBLIC OF THE PHILIPPINES)

_________________________) S.S.

AFFIDAVIT OF DAMAGE TO MOTOR VEHICLE

 I, RONN ROBBY D. ROSALES, Filipino, of legal age, single and a resident of Unit
1706 Avida Towers Intima, Quirino Avenue Extension, Paco, Manila, after having
been duly sworn to in accordance with law, depose and state that:

1. I am a the owner of a Geely Coolray SUV (Color White) with plate

number NGT 7530;

2. On 30 December 2022, while my car is parked in front of my parent’s

house in No. 328 Brgy. Tulay, Ibaan, Batangas, my car was scratched by
some mischievous children;

3. Because of which, the front bumper and hood were scratched;

4. Photos of the damage to the vehicle is attached herein as Annex “A” and
made an integral part of this Affidavit;

5. I am executing this Affidavit for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hands

this ___________________ in _____________________ Philippines.

RONN ROBBY D. ROSALES

Affiant

SUBCRIBED AND SWORN TO before me

this ___________________in_______________________Philippines, affiant
exhibiting to me his IBP ID with no. 66320 as proof of identification issued in
Mandaluyong City.

Doc. No. _____;

Page No. _____; NOTARY PUBLIC
Book No. _____;
Series of 2023.