Republic of the Philippines ) S.S.

City of ___________ )
x------------------------x

AFFIDAVIT OF DAMAGE TO VEHICLE

I, NERIO M PEREGRINO, Filipino, of legal age, married, and COMPANYDRIVER of

BOROUGH FINANCING CORPORATION with office address at Unit 2105
Antel Global Corporate Center, Julia Vargas Avenue, Ortigas Center, Pasig City,Phili
ppines, after being duly sworn to in accordance with law, hereby depose and
state:

1. That I am a duly licensed driver with Professional Driver's License No.

N02-90-144465 which is valid until 12 May 2011.2.

2. That on 23 February 2010, at around 7:30 pm, I was driving a vehicle,

with Ninna G. Castro in the passenger’s seat, owned and registered in the name of
Borough Financing Corporation which is more particularly described as follows:

Make : HONDA
Engine No. : L13Z1-1400806
Series : CITY
Chassis No. : PADGM16409V000546
Body Type : SEDAN
Plate No. : ZTL177
MV File No. : 1340-000004095

3. That while I was slowly driving along Santolan Street, Cubao towards
EDSA, a passenger Jeepney which was on the opposite lane going to Katipunan
Road, suddenly over took our traffic lane and the spare tire posed at the driver’s
side of the jeepney hit the leftside mirror of our company vehicle. As a result, the
entire left side mirror broke off fromthe said car’s body and since that passenger
jeepney was still moving forward, the detachedmirror was dragged onto the left
side of our car causing dents and further damage;

4. That the said passenger jeepney drove away without acknowledging

its liability,therefore, a case of “hit and run” that even the plate number of the
jeepney was impossibleto be ascertained;

5. That there were no traffic enforcers at the time of the accident;

6. That I am executing this Affidavit to attest to the truth of the

foregoing and insupport of the claim against the insurer for the repair of the
damage caused to the saidcompany vehicle.

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

February, 2010 at City of___________, Philippines.

Affiant

SUBSCRIBED AND SWORN to before me, this ________ TH day of May, 2008, in the City of
Mandaluyong, personally appeared Affiant who exhibited to me her LTO Driver’s License
_________________________.

Doc. No. _______;

Page No. _______;
Book No. _______;
Series of 2015.