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REPUBLIC OF THE PHILIPPINES )

CITY OF CAGAYAN DE ORO ) SS.

DRIVER’S AFFIDAVIT

I, ISAGANI A. ENAD, of legal age, married, Filipino and a resident of


Zone 4, Poblacion, Laguindingan, Misamis Oriental, after being sworn to in
accordance with law, depose and state:

1. That I am a duly licensed driver with Driver’s License No. M02-01-


052273 which is valid until December 23, 2020;
2. That on April 30, 2020, at around 4:00 o’clock in the afternoon, I was
driving a motorvehicle registered under the name of my wife Annabelle C.
Enad and in which motorvehicle is more particularly described as
follows:
Make/Model : Toyota Vios 1.3 BASE M
Body Type : Sedan
MV File No. : 1001-00000006974
O.R. No. : 000201455581410/07-07-2014
C.R. No. : 301863332
Chasis No. : NCP1512013472
Engine No. : 2NZ6996717
Plate No. : AAS1065
3. That while I was driving the above-described vehicle on the National
Highway of Loguilo, Alubijid, Misamis Oriental, from Cagayan de Oro
City to Laguindingan, Misamis Oriental, the I was hit by a flying stone
which was accidentally hit by an approaching and unknown
motorvehicle. As a result thereof, the left headlight of our motorvehicle,
the above-described motorvehicle, was broken and damaged;
4. That I am executing this Affidavit to attest to the truth and veracity of the
foregoing statements and for the purpose of our insurance claims for the
reparation or restoration of our motorvehicle and for whatever legal
purpose that this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 1st day of


July, 2020, in the City of Cagayan de Oro, Philippines.

ISAGANI A. ENAD
Affiant
Driver’s License No. M02-01-052273

SUBSCRIBED AND SWORN to before me this 5th day of March, 2018 at


Cagayan de Oro City, Philippines.

Doc. No. 489


Page No. 98
Book No. III
Series of 2020

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