Republic of the Philippines)

Tacloban City ) S.S.

AFFIDAVIT OF ACCIDENT
I, ED KERVIN ORDOVEZ RADAM, Filipino, of legal age, single, and a resident of Zone 7,
Abaca, Dagami, Leyte, after having been duly sworn to in accordance with law hereby depose
and state:

1. That I am the brother of EVE DAPHNE ORDOVEZ RADAM, the registered owner of a
motor vehicle more particularly described herein as follows, to wit:

Make: TOYOTA MV File No: 0801-00000237486

Engine No: 2NRX371984 Chassis No: PA1B2JF34J6006117
Series: VIOS 1.5 G M/T Body Type: SEDAN
Year Model: 2019 Fuel: GAS
O.R. No. 1614579713 C.R. No. 344759306

2. That since my sister is presently in the United States, I am the one currently using the
above-mentioned vehicle;

3. That on or about the first week of March 2023, while I was parking the said vehicle
inside the compound of our residence, the front bumper hit the wall of our residence
while the rear bumper hit the gate;

4. That a day after said incident, while I was parking the said car inside our compound, I
again accidentally scratched said vehicle against one of the posts in our garage;

5. That I exercised all due diligence and efforts in trying to avoid the said incident but all
such efforts were for naught;

6. That I am executing the foregoing affidavit in compliance with the requirements for
insurance claims for the above-described vehicle; and

7. I have executed this affidavit to attest to the truth and veracity of the foregoing
statements, and for whatever other legal purposes the same may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this day of 15th day of
March 2023, in the City of Tacloban, Leyte, Philippines.

ED KERVIN ORDOVEZ RADAM

Affiant
Driver’s License No. H02-21-200447

SUBSCRIBED AND SWORN TO Before me a Notary Public for and in the City of Tacloban,
Leyte, Philippines, this day of March 15, 2023. Witness my hand and seal.

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2023.