Republic of the Philippines) S.S.

City of Manila)
x----------------x

AFFIDAVIT OF VEHICULAR ACCIDENT

I, HAROLD HINGPES, single, of legal age, a Swedish national and a resident of
the Philippines with address at Filinvest II, Batasan Hills, Quezon City, after being sworn
in accordance with law, hereby depose and state that:
1. I am a duly licensed driver with Professional Driver's License No. N02-90-144465
which is valid until 12 May 2016.
2. I entered into a contract of lease of motor vehicle for the period of three (3) years
with Ian Villamin, single, of legal age, a resident of the Philippines, and the
registered owner of a car, particularly described as follows:
Make:
Series:
Body Type:
MV File No.:

HYUNDAI
STAREX
VAN
1340-00000409599

Engine No.: L13Z1-1400806

Chassis No.: PADGM16409V000546
Plate No.:
ZTS121

3. On February 3, 2015, at around 1 oclock in the afternoon, I was driving the

aforementioned vehicle on my way to my residence in Quezon City from a
meeting with Mr. Ian Villamin at Taft Avenue, Manila.
4. As I was carefully traversing a narrow two-lane street in the outskirts of Ermita,
Manila, a passenger jeepney that I was tailing from a safe distance suddenly
came to a stop without giving any signals which caused the van to hit the rear
end of the jeepney with solid impact, causing great damage to the van.
5. Said passenger jeepney is a Sarao 2011 model, bearing plate number WTW
525; that such jeepney is owned by public operator Decoroso Moreno, married,
of legal age, a Filipino citizen, and a resident of Tondo, Manila.
6. Such damage involved broken windshields, shattered headlights, and a severely
dented front end of the vehicle which would require a huge amount of money to
be repaired and restored to their original condition.
7. The aforementioned incident was an accident beyond my control after exercising
extraordinary care and diligence to safety.
8. The same extraordinary diligence and care was exercised when I immediately
called the police to execute the necessary police report, as well as Mr. Ian
Villamin to inform him of the mishap involving his vehicle.
9. I execute this AFFIDAVIT to attest to the veracity of the facts stated herein and
for insurance collection purposes.
IN WITNESS WHEREOF, I have hereunto set my hand this 4th day of February,
2015 at City of Manila, Philippines.

HAROLD HINGPES

SUBSCRIBED AND SWORN to before me, this 4th day of February 2015, by
HAROLD HINGPES who exhibited to me his drivers license with license number N0290-144465 issued at East Avenue, Quezon City, Philippines on May 12, 2013 and which
will expire on May 12, 2016.

____________________
Notary Public

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2015.