Republic of the Philippines)

Oton, Iloilo ) S.S.

x------------------------------------------x

AFFIDAVIT OF ACCIDENT

I, RYAN OCTAVIO, of legal age, Filipino, married and a resident of CM Recto

Street, Oton, Iloilo, after having duly sworn to in accordance with law, do hereby depose
and say:

1. That I am the registered owner of a motor vehicle particularly described as

follows:
Make: Toyota Engine No: ME44300
Series: Avanza Plate No. ABA-5585
CR No. 205370745 Model: 2014
2. That on February 28, 2020 at around 8:15 o’clock in the morning, I drove
the above described motor vehicle;
3. That when I reached our house at Buray Oton, Iloilo I intended to park my
vehicle in our garage and when I was about to enter in our garage, due to
miscalculation on my part I hit my vehicle in the post;
4. That the said incident was due to inadvertence and the same caused
damage on the right bumper of my motor vehicle;
5. That I execute this affidavit to attest to the veracity of the foregoing
declaration.

IN WITNESS WHEREOF, I have hereunto set my hand this ______________,

at Oton, Iloilo, Philippines.

RYAN OCTAVIO
Affiant

SUBSCRIBED AND SWORN to before me this _____________after affiant

exhibited to me his ID: ______________as proof of her competent evidence of identity.

Doc No. ____

Page No. ____
Book No. ____
Series of 2020