REPUBLIC OF THE PHILIPPINES)

GENERAL SANTOS CITY… )S.S.

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DRIVER'S AFFIDAVIT

I, LOIDA SARTO RIVERA, Filipino, of legal age, married and resident

Blk 11, Lot 7, Agan HMS, San Isidro General Santos City, after being duly
sworn to in accordance with law, depose and says THAT:
1. That I am the possessor of a car vehicle registered to my husband
ALFREDO INES RIVERA which is particularly described as follows:
Make : ISUZU
Series : DMAX 4X2 LT-X M/T
Type : DOUBLE CAB
Engine No. : 4JK1NB2944
Chassis No. : PABTFR36DF2000588
Plate No. : 130320 (temporary plate)
Color : OJJ/ Black

2. That I am a licensed driver having been issued by the Land

Transportation Office with Driver's License No. L05-06-000692, which
is valid up to November 16, 2017;
3. That on March 06, 2017, inside the compound of Lagao National High
School, located in Purok Malakas, General Santos City I accidentally hit
a road concrete fence when I navigated backward from where the
vehicle was being parked;
4. The said incident caused damage and dent in the lower portion of the
left side panel;
5. That I execute this affidavit to attest to truthfulness of the foregoing
for all legal purposes.
IN WITNESS WHEREOF, I have hereunto set my hand this March 16,
2017 at General Santos City.

LOIDA S.
RIVERA,
Affiant

SUBSCRIBED AND SWORN TO before me this March 16, 2017 at

General Santos City, affiant exhibited his Driver’s License No. L05-06-
000692.

EDSEL S. DERIS-LIM
DOC NO. : _______ Notary Public
PAGE NO. : _______ Until December 31, 2018
BOOK NO. : _______ Roll No. 50061
SERIES OF 2017 Lifetime IBP No. 013551, March 20, 2015
Local IBP No. 893983, Jan 03, 2017
PTR No. 7157185: 01-04-2017
TIN No. 925-796-797
Address: Room 7, 2/F, Leah Bldg.
Daproza Avenue, General Santos City