Republic of the Philippines)

Province of Laguna)
City of Calamba

AFFIDAVIT OF ACCIDENT REPORT

I, MARLON ABAPO, legal age, Filipino, single, and a resident of 57 Brgy. Bucal,
Calamba, Laguna, after having been sworn to in accordance with law, do hereby
depose and say THAT:
1. I am a student driver with Student Permit No. N0319S02344, which is valid
until March 07, 2020.

2. On October 27, 2019 in the morning , I was driving a company owned sports
utility vehicle registered to CRONIMET METAL PHILIPPINES INC., and
more particularly described as follows:
Make: Kia Engine No.: G4KEBH752120
Series: SORENTO EX AT 4 Chassis No.: KNAKU811BC5195770
Body Type: WAGON Plate No.: TNI 387
Year Model: 2011 MV File No.: 1380-0000057956

3. At around 11:00 o’clock AM, I was driving along South Luzon Expressway
Sucat while accompanied by my superior FELIX NONATO PEǸAS JR. who is
a duly licensed driver with Professional Driver’s Lisence No. N03-82-070634,
valid until July 08, 2024, when suddenly a ten (10) wheeler truck with Plate
No. WIF 870, driven by a certain Mr. Cesar D. Mendoza, negligently overtook
us and hit the left side near the rear wheel of the above-mentioned KIA
Sorento that I was driving.

4. The scratches and dents caused by the accident cannot be removed or fixed
by simple buffing or remedial procedures. Restitution of the vehicle to its
previous condition prior to the sustained damages will entail a lot of expenses
estimated at PHP101,000.00; Hence, the owner of the vehicle decided to
claim from its insurer.

5. I am executing this Affidavit to attest to the truth of the foregoing and in

support of the claim from the insurer for the repair of the damages caused to
the vehicle.
IN WITNESS WHEREOF, I have hereunto set/affixed my signature this
nd
22 of January 2020 at Calamba City, Philippines, with my Student Permit
No. N0319S02344, issued at LTO Calamba, Laguna, that will expire on
March 07, 2020, and my PhilHealth ID with number 08-051323816-2.

MARLON ABAPO
 Affiant
SUBSCRIBE AND SWORN TO before me this 22nd day of
January 2020 at Calamba City , Philippines.

Doc. No. :319

Page No. : 65
Book No.: I
Series of 2020