Republic of the Philippines }

City of Davao }s.s.

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AFFIDAVIT OF DAMAGE
I, EDMUNDO R. PAWAON, of legal age, Filipino, and a resident of Buhangin, Davao City,
Philippines, after having been duly sworn in accordance with law, hereby depose and say that:

1. I am the registered owner of a certain motor vehicle described as follows:

MAKE : MAZDA
SERIES : MAZDA2 SDN 1.5
BODY TYPE : SEDAN
ENGINE NO. : P520389322
CHASSIS NO. : MM7DL2SAAHW225946
CR NO. : 278749052
PLATE NO. : LAA 6938

2. On March 1, 2019 at around 1:00 o’clock in the afternoon, while I was cruising along the National
Highway from Boston, Davao Oriental to Davao City, a large rock from an indeterminable origin suddenly
hit the vehicle’s windshield. As a result, the windshield incurred a huge crack on the point of impact.

3. Despite due diligence in operating the vehicle, the sudden damage to the vehicle cannot be
avoided.

4. Likewise, on March 14, 2019 at around 2:00 o’clock in the afternoon, I parked the aforesaid
vehicle at SM City, Ecoland, Davao City, parking lot. At around 4:00 o’clock of the same day, when I
went back to the parking lot, I noticed a big dent in the back of the aforesaid vehicle.

5. I tried to diligently inquire from persons who may be present on the immediate vicinity, but not
one of them could have actually known who caused the said dent.

6. I am voluntarily executing this affidavit to attest to the truth of the foregoing facts, to apprise the
concerned authorities and entities of the matter and for whatever legal purpose the same may serve.

IN WITNESS WHEREOF, I have hereunto set my hand on March 20, 2019 at Davao City,
Philippines.

EDMUNDO R. PAWAON
Affiant

SUBSCRIBED AND SWORN TO before me this March 20, 2019 at Davao City, Philippines,
affiant having exhibited to me competent evidence of identity with Driver’s License No. L01-09-000874

Doc. No. ;
Page No. ;
Book No. ;
Series of 2019.