REPUBLIC 

OF THE PHILIPPINES)
CITY OF TAGAYTAY ) S.S.
x------------------------------------x
  

AFFIDAVIT

I, Gregoria A. Iranzo, Filipinos, of legal age, single and resident of Nacilla St.,
Country Homes 1 Tagaytay City, after being sworn to in accordance with law, do
hereby depose and say that:

1. I am a barangay tanod at
2. On date at around eight o’clock in the evening, while I was stationed I saw a car
traversing the road on a fast speed. As the truck was very fast, I
3. That upon investigation I came to know that the registered owner and the driver
the car is driving a __ car bearing Plate Number with
4. Due to the said incident, I also noticed that Mr. sustained injuries wound in his
leg, a fractured left
5. That there was no traffic enforcer at the time of incident
6. We executed this affidavit to attest to the truth and veracity of the foregoing
statements and for whatever legal purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 6 May 2021 in

Tagaytay City, Philippines.

_______________________________ _______________________________
ATHENA THERENSE IRANZO GREGORIA A. IRANZO
Affiant Affiant

   SUBCRIBED AND SWORN TO before me this 6 May 2021 in Tagaytay

City, Philippines, affiants exhibiting to me her valid proof of identification.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2021.