AFFIDAVIT OF INCIDENT

I, JULIUS VICTOR BALDELOBAR SAVELLANO, Filipino citizen,

of legal age, single with postal and residence address at No. B 14 L
29 Kalayaan Homes, Subd., Toclong, Kawit, Cavite, after having been
duly sworn to in accordance with law hereby depose and state that:

1. That I am the authorized driver of the following described-

motor vehicle, to wit:

Make: PEUGEOT
Model: 5008 20H
Plate: AAZ 1055
Color: Aluminum Gray

2. That on June 7, 2022 around 2:00 pm at the front of Mc

Donald Anabu, Imus City, Cavite, along Aguinaldo Highway,
while I was driving the abovementioned motor vehicle and
slowly turning right a female rider was riding an eBike
suddenly hit the right-side passenger’s door portion that cause
dents and scratches to the abovesaid motor vehicle. The
aforementioned accident incurred unestimated cost of
damages.

3. I am executing this affidavit to attest to the truth of the

foregoing facts and for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my hands this

th
14 day of June 2022 at Imus City, Cavite, Philippines.

JULIUS VICTOR BALDELOBAR SAVELLANO

Affiant
LTO DL ID Card No. N03-08-029367

SUBSCRIBE AND SWORN TO before me this 14th day of June

2022 at Las Piñas City, Metro Manila, Philippines.