REPUBLIC OF THE PHILIPPINES)

PUERTO PRINCESA CITY ) S.S.

AFFIDAVIT

I, HANNAH ALTHEA ARMAVE CORTEL ABIOG, of legal age, Filipino, single,

and a resident of Barangay San Jose, Puerto Princesa, Palawan after having been
sworn to in accordance with law hereby depose and state:

1. That I am authorized to drive a vehicle described as follows:

REGISTERED OWNER: ARMELITA CORTEL ABIOG

MODEL/MAKE: NISSAN NAVARA 2.5 VE M
CHASSIS NUMBER: MNTCCAD23Z0007833
ENGINE NUMBER: YD25998554T
COLOR: FORGED METALLIC COPPER
PLATE NUMBER: VAB2843

2. That on January 15, 2024 at approximately 10:30 in the morning, as I was

maneuvering in our house gate, I miscalculated the distance of the vehicle from
the gate;

3. That due to the miscalculated distance, the left side taillight and the left step
board or running board of the vehicle has been damaged;

4. That said damage to the vehicle needs repair/replacement; and

5. That I am executing this affidavit to attest to the truth of the foregoing, to support
my application for filing a claim from the insurance company and for whatever
legal purpose it may serve best.

IN WITNESS WHEREOF, I have hereunto set my hand this 6th of February 2024
at Puerto Princesa City.

HANNAH ALTHEA ARMAVE CORTEL ABIOG

Affiant

SUBSCRIBED AND SWORN to before me, this 6th day of February 2024 in
Puerto Princesa City, with affiant exhibiting his Driver’s License with No. D11-18-
000243 issued in Puerto Princesa City, Palawan.

NOTARY PUBLIC

Doc. No. : ___

Page No. : ___
Book No. : ___
Series of 2024.