REPUBLIC OF THE PHILIPPINES ]

CITY OF CAGAYAN DE ORO ] SS.

AFFIDAVIT OF ACCIDENT

I, REYNAN E. LACABA, of legal age, married, Filipino, and a resident of Zone 4,

Pasil, Kauswagan, Cagayan de Oro City, after having been duly sworn to an oath
in accordance with law, hereby depose and state that:

1. I am a holder of a driver’s license with license No. NO4-12-007077;

2. On November 19, 2020, around 1:59 PM I drove a vehicle registered

under Christine Iellyn A. Suico which vehicle is more particularly
described as follows:

Make: HYUNDAI
Type: SEDAN
Series: ACCENT 1.4 GL A
Color: RED
Chassis Number: PEHC741B3KH000244
Plate Number: KAD1075;

3. On that aforecited date and time, I parked in between Figaro Coffee

House and Red Tail Restaurant at Rosario Crescent, Limketkai Center,
Cagayan de Oro City and another car was also parked around Twenty
(20) meters behind my vehicle which is more particularly described as
follows:

Make: TOYOTA
Series: WIGO
Color: RED
Plate Number: NDS8847;

4. As I was about to leave from my parking spot, I failed to notice that the
said Toyota Wigo was also on its way to leave from its parking space
and the same passed through me while I was about to turn to the right
causing a collision;

5. The collision caused the paint scratches of the rear left side of the
Toyota Wigo, dents and scratches on the right side bumper and the
right side running board of the Hyundai Accent;

6. Due to the said accident, I am now constrained to have the vehicle I

was driving and the above mentioned car undergo some repairs to
avoid further damage;
 7. I am executing this affidavit to attest to the truth of the foregoing and
in support of the claim against the insurer for the repair of the damage
caused to the said Toyota Wigo and to the Hyndai Accent.

IN WITNESS WHEREOF, I have hereunto set my hand, this 24th day of

November, 2020 at Cagayan de Oro City, Philippines.

REYNAN E. LACABA
Affiant

SUBSCRIBED AND SWORN TO before me, this 24th day of November,

2020 at Cagayan de Oro City, Philippines by affiant REYNAN E. LACABA
exhibiting to me his driver’s license bearing license number NO4-12-007077. I
further certify that I have personally examined the affiant and that I am fully
satisfied that she voluntarily executed and understood the affidavit.

Doc. No.: _____

Page No.: _____
Book No.: _____
Series of 2020.