Republic of the Philippines)

Dumaguete City ) S.S.

x-----------------------x

Affidavit of Damage

I, NENETA ALABADO REHAWI, Filipino, of legal age, and with residence and postal address at Purok
Matinabangon, Bagacay, Dumaguete City, Negros Oriental, Philippines, after being duly sworn to in
accordance with law, hereby depose and state:

1) That I am the owner of a 3.2 Wildtrak Ford Ranger, more particularly described as follows:

Make/Type : Ford Ranger 3.2 L 4x4/Utility Vehicle

Certificate of Registration No. : 306059725
Engine No. : P5AT2570623
Chassis No. : MNCUMFF50HW806239
Body Type. : Pickup
MV File No. : 0601-0000423785
Color :
Year Model : 2018
Plate No. : 060103

2) That on August 24, 2018, while I was maneuvering to enter our garage, I heard a strong
cracking and scraping sound on the right side of the car;

3) That as I got out of the car to investigate, I noticed I had scraped the right garage post and
that there where dents and lines of scratches on passenger side reaching to the end portion
of the car;

4) That I am executing this Affidavit of Damage to attest to the truth of the foregoing facts and
to support my application for insurance claims.

IN WITNESS WHEREOF, I have hereunto set my hand this September 27, 2018, in the City of
Dumaguete, Philippines.

NENETA ALABADO REHAWI

AFFIANT

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in and for the City of Dumaguete this
September 27, 2018. Affiant personally came and appeared with her COMELEC ID No.VIN: AEDU-
0000A-B1271NAR20000, known to me and to me known as the same person who personally signed
the foregoing instrument before me and avowed under penalty of law to the whole truth of the contents
of said instrument.

PETER RODERICK M. OLPOC

Doc. No. 63 NOTARY PUBLIC
Page No. 14 COMM.S.N.2016-025. UNTIL 12/31/2019
Book No. XIII ROLL No. 60317 – 3/23/2012
Series of 2018 IBP No. 1071335 / DTE.:12/17/2017
PTR No. 1789243A – 01/04/2018
BOTH ISSUED AT DUMAGUETE CITY
MCLE COMPLIANCE No. V- May 2017
32 TINDALO ST., DARO, DUMAGUETE CITY