REPUBLIC OF THE PHILIPPINES ) MAKATI CITY ) Sc.
A F F I D A V I T
I, DIWATA AKOH , Filipino, single, of legal
age, with residence at No. 143
IloveYou St., Barangay May Forever, Makati City, after having been duly
sworn to in accordance with law, hereby depose and state that:
1. I am the registered owner
and driver of Ford Fiesta 2011 with Plate No. ABC 123;
2. I drive and use the car daily as my
service in going to my work in Quezon City and in attending to my clients in
Metro Manila;
3. On July 31, 2015, I parked my said car at ABC
Mall In Quezon City, to attend a meeting with client;
3. After
more or less, two hours, I went back to the car and found out that the left side
mirror and driver’s door were broken/damaged;
4. I did
not witness the incident and exerted my best effort to locate some witness or
witnesses as to what happened and why my car was damaged but to no avail;
5. That I am executing this affidavit to attest
to the truthfulness of the foregoing statements/facts and for whatever legal
purposes it may serve.
IN WITNESS WHEREOF, I have hereunto set
my hand this 31 July 2015 at Makati City, Philippines.
DIWATA AKOH Affiant
JURAT
SUBSCRIBED AND SWORN to before me this 31ST of July 2015,
affiant personally appeared and exhibited to me her LTO Driving License ID No. N02-12-1234-5678 issued on 16 June 2015 in Quezon City, Philippines.
NOTARY PUBLIC
Doc. No.: _____;
Page No.: _____;
Book No.:
_____;
Series of
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