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AFFIDAVIT OF ACCIDENT

I, RYAN BACONGON DEL CARMEN, Filipino citizen, of legal


age, married, with postal and residence addresses at No. B 16 L 5
Cadiz St., Montefaro Village, Brgy. Alapan 1-B, Imus City,
Philippines, having duly sworn in accordance with the law, do
hereby depose and state, that:

1. I am the duly licensed driver with Professional Driver’s


License No. D06-07-001366;

2. Likewise, I am the registered owner of a motor vehicle


which is more particularly described as follows:

Certificate of Registration 271598331


Make Suzuki
Series Ertiga GL-AT
Body Type Wagon
MV File No. 1301-00000836731
Engine No. K14BT1214110
Plate No. 130102

3. On May 26, 2022, at about 8:00 AM, the abovementioned


motor vehicle was discovered with big visible dent and
scratches at the rear lower right portion of bumper. (A
copy of photo image of damaged motor vehicle,
hereinafter referred to as Annex “A”;

4. Neither captured by Closed-Circuit TeleVision (CCTV)


camera nor people witness the incident in the place.

5. I am executing this affidavit to attest to the truth of the


foregoing facts and for whatever legal purpose it may
serve.

IN WITNESS WHEREOF, I hereunto affix my signature this


th
27 day of May 2022, Imus City, Cavite, Philippines.

_____________________________________
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RYAN BACONGON DEL CARMEN
Affiant

SUBSCRIBED AND SWORN to before me this 27th day of May


2022, in Las Piñas City, Metro Manila, Philippines.

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