DRIVER’S AFFIDAVIT

I, ZEUS I. ZEPEDA, Filipino of legal age, married, resident of and with postal address at P3 Tigbi, Tiwi, Albay,
is an owner of Nissan Navarra pick-up, after having been sworn in accordance with the law, hereby depose
and say:

1. That I am a holder of a valid Driver’s License duly issued by the Land Transportation Office, with
Driver’s License No. # ________ with expiration date on ______ with restriction code _____ which
is hereto attached.

2. That on June 21, 2018, at around 5:30 in the afternoon, I was driving the Nissan Navarra pick-up
towards our house garage when its hood accidentally bumped into the garage post due to a
miscalculated maneuver, causing a dent in the midpart of the said hood.

3. That I attest to the truthfulness of all foregoing facts and statements for all legal intents and
purposes.

IN WITNESS WHEREOF, I have hereunto signed this affidavit this ______ day of ___________, 2018 at
Legazpi City, Philippines.

ZEUS I. ZEPEDA
Affiant

SUBSCRIBED AND SWORN to before me this ______ day of ___________, 2018 at Legazpi City,
Philippines.

Doc. No. ______

Page No. ______
Book No. ______
Series of 2018