Republic of the Philippines)

Pasay City
)s.s
AFFIDAVIT of no vehicular accident
I, , of legal age, single, Filipino and with postal address at Manila, after having
been duly sworn in accordance with law depose and state that:
1. I am not the authorized driver of a motor vehicle owned., more particularly
described as follows:
Model
:
On 05 January 2003 at around 10:00 A.M. I parked
the above described vehicle along the left side of San Marcelino Street, near
corner Remedios Street in Manila;
2. When I returned at around 11:45 P.M. of the same date, I did not noticed
that the right rear quarter panel, right rear tail light and the bumper of the
Nissan Sentra was damaged;
3. I asked around the vicinity who may have bumped the NISSAN Sentra but
nobody could give any information;
4. I am executing this affidavit to attest to the truth of the foregoing and for
whatever legal purpose this may serve.
FURTHER AFFIANT SAYETH NAUGHT.
Done this 14 January 2003 at Pasay City, Philippines.

Affiant
SUBSCRIBED AND SWORN to before me this 14 January 2003 at Pasay City,
Philippines, affiant exhibiting his CTC No. 13314387 issued on 18 January 2002 at
Dasmarias, Cavite.

Doc. No.
Page No.
Book No.
Series of 2003
Affidavit(parias)