Republic of the Philippines )

City of Cagayan de Oro ) Ss

x--------------------------------------------x

AFFIDAVIT

I, ATTY. KARREN MARICRIS CACABELOS-SUR, Filipino, of legal age and a

resident of Poblacion 8, Midsayap, Cotabato, do hereby depose and state –
That:

1. I am the same Karren Maricris G. Cacabelos who filed an

insurance claim before Standard Insurance Co. on November
11, 2008.

2. Prior to the filing of said claim, I have already renewed my Land

Transporation Office (LTO) Driver’s License and was accordingly
issued, on May 8, 2008, a renewed driver’s license bearing LTO
License No. M01-97-053467.

3. I am executing this affidavit to attest to the truth of the

foregoing facts in order to facilitate my insurance claim with
Standard Insurance Co., and for whatever legal purpose it may
serve.

IN WITNESS WHEREOF, I hereunto affix my signature this

_________________, Cagayan de Oro City, Philippines.

___________________________________
ATTY. KARREN MARICRIS CACABELOS-SUR
Affiant

SUBSCRIBED AND SWORN to before me this _______________, at Cagayan

de Oro City, Philippines, affiant exhibited to me her Community Tax Certificate No.
00102605 issued on January 5, 2009 at Midsayap, Cotabato. I certify that I have
examined the Affiant and I am satisfied that she had voluntarily executed the foregoing
Affidavit and that the contents thereof had been fully explained and understood by her
before she affixed her signature thereon.

Doc. No. ______

Page No. ______
Book No. ______
Series of 2009.