Roanne G.

Santos
163 P. Santos St. Malibay
Pasay City, 1300
roannegsantos@gmail.com
09178888106

AFFIDAVIT OF OWN DAMAGE FOR VEHICLE

I, Roanne G. Santos, residing at 163 P. Santos St. Malibay Pasay City, do solemnly affirm and state as
follows:
I am the registered owner of a motor vehicle bearing the following details:

Make: Toyota
Model: Vios 1.3E GAS A
Year: 2017
MV File No: 1301-00000761677

On or about August 27, 2023, at approximately 2000H, my vehicle sustained damage as a result of
accident.
The damage to my vehicle includes, but is not limited to, the following:
 Dented rear bumper
 Broken tail light
 Dented compartment door
I have attached photographs of the damage to my vehicle as Exhibit A, which accurately depict the
extent of the damage incurred.
I understand that the information provided in this affidavit is being submitted under oath and that any
false statements made herein may subject me to legal consequences.
I declare under penalty of perjury that the foregoing is true and correct to the best of my knowledge and
belief.

Roanne G. Santos
September 13, 2023