Christelle Belo was driving her 2013 Mitsubishi Mirage when a boy on a bicycle collided with her vehicle. She was stopped at an intersection when the boy riding his bicycle looked behind him and inadvertently hit the left side fender of her car with the bicycle's steel handlebar, causing a long scratch and dent. Belo is filing this affidavit to attest to the truth of the accident and document the incident for her insurance claim.
Original Description:
AFFIDAVIT OF ACCIDENT CHRISTELLE JANE VILLAVICENCIO BELO
Original Title
AFFIDAVIT OF ACCIDENT CHRISTELLE JANE VILLAVICENCIO BELO
Christelle Belo was driving her 2013 Mitsubishi Mirage when a boy on a bicycle collided with her vehicle. She was stopped at an intersection when the boy riding his bicycle looked behind him and inadvertently hit the left side fender of her car with the bicycle's steel handlebar, causing a long scratch and dent. Belo is filing this affidavit to attest to the truth of the accident and document the incident for her insurance claim.
Christelle Belo was driving her 2013 Mitsubishi Mirage when a boy on a bicycle collided with her vehicle. She was stopped at an intersection when the boy riding his bicycle looked behind him and inadvertently hit the left side fender of her car with the bicycle's steel handlebar, causing a long scratch and dent. Belo is filing this affidavit to attest to the truth of the accident and document the incident for her insurance claim.
I, CHRISTELLE JANE VILLAVICENCIO BELO, of legal age,
Filipino, single, with postal and residence address at No. Blk 6 L 47, Cailles St., Meadowville Subd., Pasong Buaya II, Imus City, Cavite, Philippines, after having been sworn in and accordance with law, do hereby depose and say:
1.That, I am a duly registered owner and an authorized driver
of the following described-motor vehicle, to wit:
CERTIFICATE OF REGISTRATION NO.: 0023396542
MAKE MITSUBISHI SERIES MIRAGE GLS 1.2G YEAR MODEL 2013 MV FILE NO. 138400000304104 PLATE NO. FJE 408 BODY TYPE HATCHBACK 2.That, on October 2, 2023, at around 3:00 P.M., I was driving the abovesaid motor vehicle properly to the left at an intersection within the aforesaid subdivision. I noticed on my left side that there was a boy driving a bicycle. I was stopped because the minor driving the bicycle was looking behind him while moving forward in my direction. Unexpectedly the left corner of the bicycle's steel handlebar inadvertently hit the left side fender of the abovementioned motor vehicle and it caused a visible long scratch and dent on the left side fender;
3. That, the above-said incident incurred an un-estimated cost
of vehicular damage;
4. That, I am executing this Affidavit to attest to the
truthfulness of the foregoing facts and to be used for insurance claim documentary requirement compliance.
IN WITNESS WHEREOF, I have hereunto affixed my hand
this 24th day of October 2023 at Imus City, Cavite, Philippines.
CHRISTELLE JANE VILLAVICENCIO BELO
Affiant LTO DL Card No. D38-22-304083
SUBSCRIBE AND SWORN TO before me this 24th day of
October 2023at Las Piñas City, Metro Manila, Philippines.