REPUBLIC OF THE PHILIPPINES)

Quezon City, Philippines ) S.S.

AFFIDAVIT OF DAMAGE TO VEHICLE

I, JEZREL MOLAVIN BAYKING, of legal age, Married, Filipino, with postal

address at Nico St. Miag Ao, Iloilo, after having been sworn in accordance with
law hereby depose and state that:

1. I am the duly licensed driver with Licensed No. F03-93-074422 which is valid
until January 24, 2032;

2. That on February 10, 2024 around 10:00 o’ clock in the evening on Sunday, I
was driving a Toyota Innova 2.8V with Plate No. DBH7051, accident occurred as I
turn right between Edsa Ave. Corner Corinthians Road heading to Temple Drive,
other vehicle collided with mine at that intersection. However, the driver of that
vehicle immediately left the scene of the accident without stopping to provide any
information or assistance;

3. Despite my attempts to follow the other vehicle, I was unable to obtain any
identifying information, such as the make, model, or Plate No. of that vehicle;

4. As a result of the collision, the vehicle sustained significant damages to the left
back bumper including the brake-light;

5. The impact caused visible dents, scratches, and structural damages to the
bumper, rendering it inoperable;

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6. That I am executing this affidavit to attest to the truth of the foregoing and in
support of my claim against the insurer for the repair or replacement of such
damage to the said vehicle.

IN WITNESS WHEREFOR, I have hereunto set my hands this February 16, 2024
at Quezon City.

JEZREL MOLAVIN BAYKING

Affiant

SUBRCIBED AND SWORN TO before me this ____________________ at

Quezon City affiant exhibit to me licensed driver with Licensed No. F03-93-
074422 issued by LTO.

WTNESS MY HAND AND SEAL

Doc No._______
Page No._______
Book No.______
Series of 2024

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