Affidavit Of No Own Damage Claim.docx

REPUBLIC OF THE PHILIPPINES} CITY OF CEBU } S.S.

AFFIDAVIT OF NO OWN DAMAGE CLAIM I, DON JUAN , of legal age, Filipino, single with office address at Bantal, Mindoro, after having been sworn in accordance with law hereby depose and state that – 1.

I am the Corporate Secretary for Bantal Agro-Industrial Corporation;

2. Bantal Agro-Industrial Corporation is the owner of a Mitsubishi L300 FB vehicle (hereinafter referred to as “ Vehicle”) with Plate no. MPN 682 and covered by Certificate of Registration no. 10443192-4; 3. Sometime on February 4, 2019, at around 8:30 P.M. more or less, the said vehicle while parking suffered damages when it was hit by another vehicle owned by the Bantal Municipality Government; 4.

The vehicle has no OWN DAMAGE insurance coverage;

5. I hereby CONFIRM and ATTEST that Bantal Agro-Industrial Corporation has not filed any claim for OWN DAMAGE in connection with the damages on the subject vehicle; 6. I am executing this Affidavit in order to attest to the truth of the foregoing statements for whatever legal purposes this may serve. I have nothing further to say. IN WITNESS WHEREOF, I have hereunto affixed my signature this ____ day of March 2019, in Bantal, Mindoro, Philippines.

DON JUAN Affiant SUBSCRIBED AND SWORN to before me this ____ day of March 2019 at Bantal, Mindoro, Philippines personally appeared DON JUAN, who exhibited to me his competent proof of identity written below his name. I HEREBY CERTIFY that he voluntarily signed and executed this Affidavit.

Doc. No. ______ ; Page No. ______ ; Book No. ______ ; Series of 2019.