March 7, 2023 Self Accident
March 7, 2023 Self Accident
POLICE REPORT
(SELF-ACCIDENT)
On March 7, 2023, at about 12:20 PM, personally appeared to this office one
Keith Allen Garcia y Pineda, 19 years old, single, male, filipino, and a resident of Brgy
Poblacion Norte, Salcedo, Ilocos Sur with Driver’s License number A11-21-202823
which expires on Nov. 8, 2025 to report a self-accident that transpired along Sta Rosa-
Ft. Magsaysay rd. Brgy. Soledad, Sta Rosa, N.E on March 2, 2023 at about 10:00 AM
his driven vehicle one unit Yamaha NMAX bearing plate number 580ATR, Engine
number G3L8E-0474241 owned by Jose L Bilaoen Jr.
According to the reportee on said time date and place of the incident, while he
was traversing said road when unable to control his balance due to the uneven concrete
road that resulted in a crushed/accident.
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This police report is being issued this 7th day of March 2023 here at Santa Rosa,
Nueva Ecija upon the request of the party involved for whatever legal intent and
purposes it may serve.
Prepared by: