REPUBLIC OF THE PHILIPPINES}

MUNICIPALITY OF PATEROS }S.S.

METRO MANILA }

AFFIDAVIT OF DAMAGES

I, GERARD S. ESTELLA, Jr., of legal age, Filipino and resident of

2444 Nakar Street, San Andres Bukid, Manila, after having been duly
sworn, do hereby depose and say –

1. That I am the registered owner and authorized driver of that

certain motor vehicle MITSUBISHI MIRAGE with Plate No.
_____________________.

2. That I am parking the aforesaid motorvehicle outside our residence

located at the above stated address.

3. That my vehicle sustained the following damages:

a. Scratch at the left quarter panel

February 2020
b. Dents and Scratches at the Rear Bumper Face Kit
February 2020
c. Scratch at the Tail Gate Panel
December 2019
d. Scratch at the right quarter panel and wheel arc
2019
e. Scratch at the Right Rear Door Panel
2020
f. Right Door Panel – Scratch
2020
g. Right Fender Panel – Scratch
2020
h. Right side mirror cover
2019
i. Front Bumper Face Kit
2019
j. Hood Panel – Scratch
2019
k. Left Side Mirror Cover
2019
l. Left Fender Panel
2020
m. Left front door panel
2020
n. Left rear door panel
2020
o. Left quarter and Wheel arc
2020
p. Gas Lid cover
2020
q. Tail Gate Trim
2020
r. Dents - Roof Panel
May 20, 2021

1
3. That what happened was purely accident and beyond my control
as the authorized driver and registered owner of the above
described motor vehicle.

4. That I am executing this affidavit to attest to the truth of all the

foregoing for all legal intent and purposes specifically for the repair
of the damages caused to the car MITSUBISHI MIRAGE with Plate
No. _____________________..

IN WITNESS WHEREOF, I have hereunto set my hand this May

31, 2020 at Pateros, Metro Manila.

GERARD S. ESTELLA, Jr.

Affiant
ID No. ______________________

SUBSCRIBED AND SWORN to before me this May 31, 2020 at

Pateros, Metro Manila with Affiant affixing his signature in my presence
and within my notarial jurisdiction.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2021*