REPUBLIC OF THE PHILIPPINES)

PROVINCE OF AKLAN
) S. S.
MUNICIPALITY OF KALIBO
)
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AFFIDAVIT
I, GERALD BRIONES ISTURIS, of legal age, Filipino, single, resident of
Briones, Kalibo, Aklan, Philippines, after having been duly sworn to in
accordance with law depose and say:
That on August 18, 2014, while I was walking along the road in Briones,
Kalibo, Aklan, a motorcycle suddenly hit me;
That the motorcycle was identified as Honda 110, color blue, owned
and driven by Panfilo C. Tamoso;
That the by reason of the incident, I incurred physical injuries, as
shown in in a medico legal report of the physician that examined me;
That the said incident has been reported and recorded before the
Kalibo Police Station;
That Panfilo C. Tamoso does not deny liability by reason of the
accident;
That I and Panfilo C. Tamoso have already settled the civil and criminal
aspects of the said incident and I hereby expressly state that I am no longer
interested in filing civil or criminal case against Panfilo C. Tamoso.

That I am executing this affidavit to attest to the foregoing facts.

IN WITNESS WHEREOF, I have hereunto set my hand on this 23 rd day

of _____________________________ at Kalibo, Aklan, Philippines.

GERALD
BRIONES ISTURIS
Affiant
SUBSCRIBED AND SWORN to before me on this 26 th day of August 2014
in the Municipality of Kalibo, Province of Aklan, Philippines. Affiant GERALD
BRIONES
ISTURIS
showed
to
me
____________________________________________ to prove his identity.