Republic of the Philippines )

City of Paranaque )S.S

AFFIDAVIT

I, Macario M. Velo II, of legal age, Filipino, with residential address at

______________________________________________________________________________
___________________ after having sworn in accordance with law herby depose and state that:

1. On October 15, 2017 around 1pm, my family went to Western Appliance Store in Las
Pinas, City;
2. I was about to park my Isuzu MU-X 4X2 3.0 AT with conduction sticker CR 5266, I did
not notice that there is a motorcycle parked beside my car;
3. I had a hard time reversing my car due to the narrow space and then suddenly I hit the
rear side of the Toyota Vios with plate number PFI 638 registered under the name of
Joseph Cabral;
4. Mr. Cabral and I went to an agreement that my insurance company will shoulder the
expenses of the car repair that the former sustained;
5. Based on the quotation that we have agreed upon, my insurance will shoulder the
payment for the Repair Siding & Re-Align Tail Light amounting to Php 5,500 and
Repaint Siding & Rear Bumper including its Labor amounting Php 5,000 with a total of
Php 10,500.
6. I am executing this Affidavit to attest the truth of the foregoing and for all legal intents
and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand _____ day of 2017 at _____________.

___________________

Macario M. Velo II
Affiant

SWORN AND SUBSCRIBED to before me this ____ day of ___________, 2017 the affiant
personally appeared and exhibited his competent evidence of __________.

Doc No. ________

Page No. _________

Book No. __________

Series of 2017