REPUBLIC OF THE PHILIPPINES) Roxas City, Province of Capiz ) S.S.

AFFIDAVIT

I, Pedro Garcia, Filipino, of legal age, single and a resident of __________________, having been duly sworn in accordance with law, hereby depose and state: 1. That on March 16, 1979, on my way to work at around 8:15 A.M. I was about to cross the street when a truck with Plate No. PDA 122 owned by Concepcion Refrigerating Co. suddenly came from around the corner and hit me; 2. That I didnt hear any horn blowing or see the truck coming in my direction; 3. That after the truck hit me, I was bleeding and I became unconscious; 4. That as a result of the incident, I sustained the following injuries; severe laceration on the back of my head, a cut on my right eye, bruises over the right side, fracture on my left leg and left arm and contusions on my back. 5. That the said incident was witnessed by many persons, most of whom are walking along the road and has been duly documented in the Blotter of the City Police Division; 6. That the driver is Juan dela Cruz, and is acting on his capacity as an employee of Concepcion Refrigerating Co. and his negligence resulted to the accident; 7. That I am executing this Affidavit to attest to the truth of the foregoing and in support of the charges for RECKLESS IMPRUDENCE RESULTING TO PHYSICAL INJURIES against the driver of the truck or for whatever other action that may be filed against the driver and/or the company where he worked for and in support of the claims for indemnity for the damages. IN WITNESS WHEREOF, I have hereunto set mu hand this _ day of March 23, 1979 in Roxas City, Capiz, Philippines.

PEDRO GARCIA Affiant (JURAT)