Affidavit of Accident I, JOSE R. RAMOS, of Legal Age, Filipino and A Resident of U1176 Skyway

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REPUBLIC OF THE PHILIPPINES)

CITY OF PASIG )S.S.

AFFIDAVIT OF ACCIDENT

I, JOSE R. RAMOS , of legal age, Filipino and a resident of U1176 Skyway


Twin Towers, No. 351 Capt. H. Javier St. Oranbo, Pasig City, after having been
duly sworn in accordance with law, hereby depose:

1. Sometime on June 28, 2017 at around 6:30 am while backing my car


Black SUV, BMW X-3, model 2014 with Plate No. ATA 9774 on the
basement 2 of the parking area of the building where I resides, the front
door of the driver’s side hit the concrete base (big post) of the said
building;

2. The incident resulted to a damage on the front door of the driver’s side
of my vehicle;

3. That no police officer was around the vicinity on that date so that I was
not able to report the incident.

4. That I am executing this affidavit to attest to the truth of the foregoing


allegations and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this


_________, at Pasig City.

JOSE R. RAMOS
Affiant

SUBSCRIBED AND SWORN TO before me this _______________ in Pasig


City, affiant exhibiting to me his SC ID No. 32506, issued t Pasig City.

Doc. No.
Page No.
Book No.
Series of 2017.
SINUMPAANG SALAYSAY
(AFFIDAVIT OF ACCIDENT)

AKO, ROWEL PRISADO, 42 taong gulang, Pilipino, at nakatira sa Valenzuela


City, matapos makapanumpa ng naaayon sa batas ay nagsasaysay ng mga
sumusnod:

1. Ako po ang nagmamaneho ng AI-ACE na may plakang PQA-268, na pag-


aari po ni Dr. IMELDA ALLFORJA EMITERIO;

2. Galing po kami ng Kapitolyo, Pasig City, at pagdating po naming ng


Pioneer crossing, wala naman po stop light kaya bigayan lang.

3. Paderecho po kami papuntang Greenfield, nakalagay nap o kam I sa


unang lin ya ng may nag u-turn galling San Antonio Village na sasakyan;

4. Nag-overtake yun sa kotse na nasa likod, mabilis and takbo nya na


nabulaga sya na kami ay patawid na at dun na po siya bumanga sa amin.

SA KATUNAYAN NG LAHAT NG ITO, ako po ay lumagda ngayong ika-23


ng Agosto, 2016, dito sa Pasig City.

ROWEL PRISADO,
, Affiant

SUBSCRIBED AND SWORN TO before me this 23 rd day of August 2016 in


Pasig City.

Doc. No.
Page No.
Book No.
Series of 20l6.

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