epublic of the Philippines) Province of_________________) S.S. City/Municipality of___________) x------------x AFFIDAVIT I, Chester C.

Castanos, Filipino, of legal age, married, and a resident of XH206, Xavier Hall, Xavier University, Cagayan de Oro City, Philippines, after being sworn to in accordance with law, hereby depose and state that: 1. I am a duly licensed driver with Driver's License No.123456 which is valid until January 1, 2014; 2. On 21 November 2013, at around 7:30 in the morning, I parked a Mitsubishi Lancer with Plate No. XXX 111 owned and registered in my name, outside of Dunkin Donuts Divisoria; 3. 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.

Republic of the Philippines ) City of Makati ) S.S. x--------------------------x

AFFIDAVIT
I, LIZA S. DELA CRUZ of legal age, Filipino citizen, widow and presently residing at 3333 M. Ocampo Street, Pio del Pilar, Makati City, after having been duly sworn to in accordance with law, do hereby depose and say:

1. That I am the widow of BENITO D. DELA CRUZ who died on July 30, 2013 in Quezon City because of head injuries sustained in a vehicular accident as per autopsy result conducted by Dr. Lito R. Santos; 2. That per investigation of the Quezon City Police Station, my husband was driving along the northbound lane of EDSA in front of Camp Aguinaldo in Quezon City when he was hit/bumped by a truck coming from the opposite direction; copy of the Traffic Investigation Report is hereto attached as Annex "A"; 3. That at the time of the incident, my husband was a duly licensed driver carrying Driver's License No. 123456 and was riding on a Toyota Innova, gray in color and with Plate No. XYZ-123 owned by me with Certificate of Registration No. 55667788; 4. That I am executing this affidavit in support of my application for insurance claim with _____________, to attest to the truth of the foregoing, and for whatever legal purposes it may serve. IN WITNESS WHEREOF, I have hereunto set my hand this 6th day of October 2013 at Makati City, Philippines. LIZA CRUZ S. DELA

Affiant

SUBSCRIBED AND SWORN to before me this 6th day of October 2013 in the City of Makati, Philippines, affiant exhibiting to me her competent evidence of identity by way of Philippine Passport No. 12344 issued at Manila, Philippines on September 5, 2012. Doc No. : _____ Page No.: ______ Book No.: ______ Series of 2013

Notary Public