Republic of the Philippines )

City of Tacloban ) S.S

X - - - - - - - - - - - - - - - - - - -x )

AFFIDAVIT

I, ELEANOR D. BAULA, of legal age, Filipino, single and a resident of Block 4, Lot
16, Eufrocina Drive, Villa Dolina Township, Bgy. 82. Marasbaras, Tacloban City, after
being duly sworn in accordance to law, do hereby depose and state:
1. That I am the absolute and registered owner of a 2014 Toyota WIGO
motor vehicle with Plate Number AAW 5448;

2. That my above-described motor vehicle is covered by Certificate of

Registration No. 198193914 and Registration Official Receipt No.
576366022 duly issued on July 11, 2014;

3. That on June 25, 2017, at about 5:45 in the afternoon, I parked my said
vehicle at Jones St., Tacloban City and then walked to go to various
establishments;

4. That when I returned to my vehicle, I noticed that there were already

damages/dents, scratches and that door on the driver’s side was
already badly damaged;

5. That I inquired from the people who were around in the area if they
saw how and who caused the damages to my motor vehicle but none
of them informed me as they alleged to have not seen the incident and
for which reason I made the conclusion that it was caused by a hit and
run incident;

6. That I attest to the truth and veracity of the foregoing statements and
am executing the same for the purpose of reporting to and informing
my vehicle insurer of the damages to my herein described motor
vehicle and for whatever other legal purpose that this may serve.

IN WITNESS WHEREOF, I hereunto have set my hand this 14 th day of July 2017 at
City of Tacloban, Leyte.

ELEANOR D. BAULA
Affiant
Land Bank Employee ID No. 9629

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public for the City of
Tacloban and in the Province of Leyte, this 14th day of July 2017 at City of Tacloban,
Philippines. The affiant exhibited to me her Employee’s ID, with her signature and
picture appearing therein, and am convinced and satisfied that she executed the
same freely and voluntarily.

Doc. No.
Page No.
Book No.
Series of 2017