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AKNOWLEDGMENT/PROOF OF LOSS AND DAMAGES
I, BELMONTE, IVAN REX BAUTISTA, of legal age, single, Filipino citizen,
residing at 0392 San Miguel St. Tuktukan, Guiguinto, Bulacan, hereby, driver of the vehicle with plate no. registered under the name of Mr. Reyante Belmonte acknowledges the damages I caused to the vehicle driven by Mr. Decano Santos registered under the name of Helen J. Santos and promises to pay for the repair of the said vehicle upon demand by the latter.