AFFIDAVIT OF ACCIDENT

I, KIM KERVIN BONITE, of legal age, Filipino citizen and a resident of Brgy.
Tiza, Roxas City, Capiz, Philippines, after having been duly sworn in accordance with
law, do hereby depose and state that:
I am the driver and owner of one (1) unit motor vehicle particularly described
as follows:

MAKE: MITSUBISHI MV FILE NO. 0401-00001295786

SERIES: STRADA GLS 2.4D ENGINE NO. 4N15UGR6625
CHASIS NO. MMBJLKK10LH042696 CONDUCTION STICKER: B8 F639

The above-mentioned vehicle was involved in the following vehicular accident

on the place, date and time mentioned below, and the circumstances are follows:
At around 7:00 in the rainy evening of November 04, 2021, while driving and
was about to park the above-mentioned vehicle in Brgy. Tiza, Roxas City, Capiz, a
swift and sudden swing of the gate, caused by the strong winds, hit the back left
portion (just below the tail light) of my vehicle causing its distortion and dents.
I hereby attest the truthfulness of the foregoing facts for all legal intents and
purposes.
IN WITNESS HEREOF, I hereunto affix my signature this 5th day of November
2021 in Roxas City, Capiz, Philippines.

KIM KERVIN B. BONITE

Affiant

SUBSCRIBED AND SWORN TO me this ________ in the City of Roxas,

Province of Capiz, Philippines. Affiant exhibited to me his IBP ID bearing a Roll of
Attorneys No. 74685.

Doc. No. ___

Page No. ___
Book No. ___
Series of 2021.