Republic of the Philippines )

Province of Palawan )S.S.

City of Puerto Princesa )
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AFFIDAVIT

I, ZYRA CANDELLE V. MARTINEZ,Filipino, of legal age,single and a

resident of Gabuco Road 3, Barangay San Jose, Puerto Princesa City,
Philippines, after being sworn to in accordance with law, depose and state:

1.That I am a duly licensed driver with Driver's License No.D1115003801

which is valid until July 23, 2022.

2. That on July 2, 2017 at around 11:30 in the evening, I was driving a

motor vehicle owned and registered in my name which is more particularly
described as follows:

Make:Toyota Wigo Engine No.:1KRA400837

Chassis No.: MHKA4DE5FHJ000433 Year Model:2017
Conduction Sticker: VZ5253

3. That while I was entering our driveway to park my car, the

aforementioned vehicle suddenly hit the post of our gate and as a result
the said vehicle sustained damage at its right portion of the bumper;
4. That I am executing this Affidavit to attest to the truth of the forgoing
and in support of the claim against the insurer for the repair of the
damage caused to my vehicle.

IN WITNESS WHEREOF,I have hereunto set my hand this 3 rd day of July

2017 in Puerto Princesa City, Philippines.

ZYRA CANDELLE V. MARTINEZ

Affiant

SUBSCRIBED AND SWORN to before me this 3 rd day of July 2017 at Puerto

Princesa City. Affiant exhibited to me the valid proof of her identity as
shown by her PRC License, with No. 0785614 issued by PRC, Manila.

Doc.No_____;
Book No.____;
Page No.____;
Series of 2017