AFFIDAVIT OF ACCIDENT

I, BERNADETH GUEVARRA DEOCAREZA, Filipino citizen, of

legal age, single with postal and residence addresses at No. B 8 L 5
Greenside Homes Subd., Malagasang 2-D, Imus City, Cavite,
Philippines, and upon my oath, do hereby depose and state - That:

1. I am the duly registered owner and likewise a licensed

driver with LTO Driver’s License No. D06-15-000848 of a
motor vehicle which is more particularly described as follows:

Certificate of Registration No. 37229839-3

Make Toyota
Series Fortuner 4x4 G
Body Type SUV
MV File No. 1301-0000-1452116
Engine No. 2GDC624973
Plate No. NGF8590

2. On July 31, 2022, at about 1:30 PM., the

abovementioned motor vehicle was travelling along
Malagasang Road corner Patio Tirona Road, Imus City,
Cavite, from Manila Memorial Park, Dasmariñas City,
and was going back home at the above-said residence
address when suddenly a Toyota Hi-Lux with plate
number DAQ1869 driving from Patio Tirona Road turned
left, accidentally hit the abovesaid motor vehicle;

3. Thereafter, City of Imus Traffic Management Officers

(CITMO), attended the aforesaid incident when parties
were required by the abovesaid officers to submit their
LTO Driver’s License for verification the driver of a Toyota
Hi-Lux with plate number DAQ1869 abruptly escaped
and abandoned the adverse party and the
abovementioned motor vehicle; (A copy of Barangay
Blotter dated 31st day of July 2022, hereinafter referred
to as ANNEX “A”)

4. A Closed-Circuit Television (CCTV) captured and

recorded the hit and ran incident;

5. Due to that incident, the aforesaid motor vehicle incurred

an un-estimated cost of damages;

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 6. I am executing this affidavit to attest to the truth of the
foregoing facts and for whatever legal purpose it may
serve.

IN WITNESS WHEREOF, I hereunto affix my signature this

1st day of August 2022, in Imus City, Cavite, Philippines.

_________________________________________
BERNADETH GUEVARRA DEOCAREZA
Affiant
LTO DL Card No. D06-15-000849

SUBSCRIBED AND SWORN to before me this 1st day of

August 2022, in Las Piñas City, Metro Manila, Philippines.

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