Affidavit of Damage to Vehicle Hitting a Post while Backing Republic of the Philippines) Province of_________________) S.S.

City/Municipality of___________) x------------x AFFIDAVIT I,____________,Filipino, of legal age,(single / married / widow),and a resident of__________, 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._____________covered by DLR No.___________, which is valid until___________. 2. That on___________, at around_______, I was driving a motor vehicle owned and registered in my name which is more particularly described as follows: Make____________ Motor No.:____________ Series:__________ Chassis No.:___________ Body Type:___________Plate No.:_____________ Year Model:___________MVRR No.:____________ 3. That while I was slowly backing out of the driveway along__________Street,____________,to park my car at the parking area of___________, the aforementioned vehicle suddenly hit the post of the building from where I was backing out and as a result the said vehicle sustained damage at its __________; 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___________in___________, Philippines. AFFIANT (JURAT)

Affidavit of Declaration of Ownership of Real Property Republic of the Philippines) Province of ____________________)S.S. City/Municipality of _____________) x----------x DECLARATION OF OWNERSHIP I, _____________, of legal age, Filipino, Manager of _____________ Corporation, after having been duly sworn to in accordance with law, hereby depose and state, that: The said Corporation is the owner of certain parcel of land, more particularly described as follows: (Technical Description of Property) That the said aforementioned Transfer Certificate of Title over said property includes and contains all the permanent improvements and buildings located and situated thereon. That I execute this Affidavit to attest and declare the truth of the foregoing facts and for whatever legal purposes that this Affidavit may serve. IN WITNESS THEREOF, I have hereunto affixed my signature this _____________ at _____________, Philippines. AFFIANT (JURAT)

Affidavit of Loss OR CR of Motor Vehicle Republic of the Philippines) Province of________________) S.S. City/Municipality of_____________) x---------x AFFIDAVIT OF LOSS I,_____________, Filipino, of legal age,(single / married / widow),and a resident of_____________, Philippines, after being duly sworn in accordance with law, depose and state: That I am the registered owner of a certain motor vehicle, which is more particularly described as follows: Make:_____________ Series:_____________ Type of Body:_________ Motor No.____________ Chassis No.___________ Yr. Model_____________ Color_____________ Plate No.____________ That as a registered owner, I was issued a Certificate of Registration (C.R.) and an Original Receipt (O.R.) for my registration for the year_______by the Land Transportation Office of_____________City, Philippines; That when I was about to register the said motor vehicle for year_________, I could no longer find said Certificate of Registration and Official Receipt of the said motor vehicle. That despite diligent search and efforts to locate the said documents, I could no longer find the same such that I believe that they are now lost beyond recovery. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing and to support my application for the issuance of new Certificate of Registration and Original Receipt, in lieu of the ones that were lost. IN WITNESS WHEREOF,I have hereunto set my hand this_____________in the City of___________, Philippines. (JURAT)

GENERAL AFFIDAVIT REPUBLIC OF THE PHILIPPINES ) ____________________ ) SS. I, ____________________, Filipino, of legal age, single/married to ____________________/widow/widower, and a resident of ____________________, after having been duly sworn in accordance with law, hereby depose and say: (list statements, numbered consecutively) IN WITNESS WHEREOF, I have hereunto affixed my signature this day of 20___ at , Philippines. _________________________________ (Signature of Affiant over Printed Name) SUBSCRIBED AND SWORN TO before me, a notary public in and for _____________________ this ____ day of ____________ 20___. The affiant, whom I identified through the following competent evidence of identity: (ID type and number), valid from (date) to (date) issued by (issuing authority), personally signed the foregoing instrument before me and avowed under penalty of law to the whole truth of the contents of said instrument. Notary Public Doc. No. ..; Page No. .; Book No. .; Series of 2010.

REPUBLIC OF THE PHILIPPINES) ________ CITY ) SS. AFFIDAVIT

REPUBLIC OF THE PHILIPPINES) _____________________ AFFIDAVIT ) SS.

I, ________________, Filipino, of legal age, with address at __________________________________, after having been sworn to in accordance with law hereby depose and state that: 1. ] 2. ] STATE THE FACTS! 3.] 4. I herein attest to the truthfulness of the foregoing facts.

I, ________________________, of legal age, ____________, and with address at ___________________________, under oath, state: 1. 2. 3. THAT I __________________________; xxxxxx xxxxxx

4. THAT I am executing this Affidavit to attest to the truth of the foregoing facts and to use the same for whatever legal purpose it may serve. IN WITNESS WHEREOF, I hereunto affix my signature this _________________ at ________________________. _____________________ Affiant ________________

AFFIANT FURTHER SAYETH NAUGHT. IN WITNESS WHEREOF, I hereby affix my signature this ___ day of __________200__ in ___________ City.

_______ Affiant

SUBSCRIBED AND SWORN to before me this _______________ at _______________, Affiant exhibiting to me his/her Comm. Tax Cert. _____________ issued at ______________ on _________________. Doc No. ________; Page No. _______ ; Book No. _______;

SUBSCRIBED AND SWORN to before me, a Notary Public, this ___ day of ____________ 200__ at _____________ City, affiant exhibited to me his Community Tax Certificate No. ____________ issued on ______________ at ______________.

Doc. No. ; Page No. ; Book No. ; Series of 200_.

Series of ________.