REPUBLIC OF THE PHILIPPINES )

CITY DASMARINAS. . . . . . . ) S.S.

PROVINCE OF CAVITE

A F F I D A V I T OF ACCIDENT

I, RODOLFO CRUEL III, Filipino, of legal age, and a resident of B216 L7 Ph

2, Mabuhay City Subd., Paliparan 3, Dasmarias City, Cavite,, after being duly
sworn to in accordance with law, depose and state: That - -

1. I am the authorized driver of DENISSE S. CRUEL who is the registered

owner of a motor vehicle particularly described as follows:

MAKE : TOYOTA
SERIES : AVANZA 1.3 E AT
ENGINE NO. : 1NRF273554
CHASSIS NO. : MHKM5EF2FHK008602

2. Unfortunately, on the 23rd of August 2017, at around 10:30 a.m, while I

was driving along the road of Brgy. San Francisco 2, Dasmarias City, a
certain motorcycle bumped the rear end of the above said vehicle that I
was driving.

3. The driver of the unknown motorcycle escaped quickly and left.

4. On account of said accident, the rear end of the vehicle was damage;

5. Further, I hereby declare under oath that I exerted sincere efforts to

ascertain who and what caused the above-mentioned damages but to no
avail;

6. That I am executing this affidavit to attest to the truth and veracity if the
foregoing statements and for whatever legal purpose the same may serve;

IN WITNESS WHEREOF, I have hereunto affixed my signature this 25th day

of August 2017 in Dasmarias City, Cavite.

RODOLFO CRUEL III

Affiant

SUBSCRIBED AND SWORN to before me this 25th day of August 2017

affiant exhibiting to me his Driver License No. D2317002792.

Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2017