UNIVERSAL AUTOSALES & SERVITECH Sayre Highusay, Poblacion, Maramag, Bukidnon ‘TiN: 182:526-999-001, ‘univesalauto,lagroup@yahoo.com 0017-772.3537 ‘BODY AND PARTS QOUTATION pare [Apri 16,2024 PlsteNo: KAP S264 ve: PRUDENTIAL INSURANCE IModet: 12023 NISSAN NAVARRA2.5 VEC Poucy # lrrameno: | MNTCCAD23Z0016166 Jcuenr name |LARRY C. BAHIAN encine: | ¥D25034726U ADDRESS POBLACION, KITAGTAO BUKIDNON |cotor /coue: contacto: _[at71186044 est 2024400 TABOR AND Item No. Description quantity UNIT PRICE Parts MATERIALS [SCOPE OF WORK REPLACED PARTS [REAR BUMPER ASSY 186.00] ALIGNMENT AND REPAIR [TAIL GATE 3,500.00] |RETOUCH AND REPAINT [TAIL GATE INNER 5,300.00 [TAIL GATE OUTER 5,800.00] REAR BUMPER STEP SHELL LHRH 5,500.00] REMOVE AND REPLACE AFFECTED PARTS TO GIVE WAY REPAIR 2,500.00| TOTAL 21,188.00] 23,100.00} [GRAND TOTAL 104,288.00} 1. Replaced parts/waste materials not claimed within six (6) day from release ofthe unit shall be disposed of by Universal Autosales & Servitech, 2. During the course of repair, unforeseen damages and defective parts ae subject to additional charges and supplementary request by Universal Autosales & Servitech 5. customers willbe given 15 days to proceed withthe repair of the vehicle upon notification of ts parts arrival. no repair took place after the given period, insurance company/customer shall pay Universal Autosales & Servitech for the costo all parts and accessories including shipping and feights. 4. For unit vehicles, if nsurance/customer chooses nat to proceed with the actual repalt the Insurance/customer agrees to pay the storage fee (P500) forthe first 100 days 5. Failure to pay the storage fee as stated in the preceding paragraph shall authorize Universa ‘Autosales & Servitech to sell the vehicle at pubic PREPARED BY: ‘EPERATION SUPERVISOR 0966-953.1224Republic of the Philippines] Province of Bukidnon } Ss. City of Valencia } DRIVER’S AFFIDAVIT I, LARRY CELDA BAHIAN, of legal age, married, Filipino citizen, and resident of Purok 5, Poblacion, Kitaotao, Bukidnon, after having been duly sworn to in accordance with law hereby depose and state that: 1, That I am the registered owner of UTILITY VEHICLE particularly described as: Make : NISSAN Color : Alphine White Body Type : Pick-up Chassis No. : _ MNTCCAD23Z0016166 MV File No. + 1001-00000725580 Engine No. : ¥D25031726U Plate No. : KAP9284 Series : NAVARA 2.5 VEC Model : 2023 2. That on April 14, 2024 at around Nine Thirty in the evening (9:30pm) more or less at Purok 8, Bangbang, Poblacion, Kitaotao, Bukidnon, while I am attending a burial wake and was about to backing up, slowly and cautiously, and suddenly the electricity went out, unfortunately, the rear portion of the said vehicle accidentally hit the huge tree, resulting to damage the back part and Left side bumper of the said vehicle. That the same was due plainly to accident. 3. That I am executing this Affidavit to attest to the truth of the foregoing facts in compliance with the requirement for my insurance claim before the office of Prudential Guarantee Insurance and for whatever legal purposes that this affidavit may serve. IN WITNESS WHEREOF, | ee, sign these presents this 16" of Issued by: LTO SUBSCRIBED AND SWORN to before me this 16" day of April 2024, in the City of Valencia, Bukidnon, Philippines. Page No.” 4; Book No.~ 9; Series of 2024.Ee , LAND TRANSPORTATION OFFICE © GS East Avenue, Quezon Cy | fied Orie R10 New Reaistation Unity, of o “ a fe 472697735 ome ea — = ang aT aoa, DEPARTMENT OF TRANSPORT LAND TRANSPORTATION OFFICE 7 ast Avenue, Quezon Cty Field Office: Field Office Code: —ygqq7— TUbISD4180 | Canad DATE: | ‘RECEIVED FROM (Lastname, Fist name, Mi) me . y. Province Zip Code) [PUROK 6 POBLACION -KITAGTAG BUKIDNON | Notvalid itnot accompanied by OR and CHG f for hii ~ TOTAL AMOUNT PAID mt “THE BUN OF ti pss) a 2