REPUBLIC OF THE PHILIPPINES)

CALAMBA CITY : S.S.

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AFFIDAVIT OF ACCIDENT

I, ZOSIMO GLOR ZARA, of legal age, single, Filipino Citizen, with resident of and
postal address at Mahogany Villas, Looc, Calamba City, after having been duly sworn to in
accordance with law hereby freely depose and say;

That I am the owner/driver of Toyota Innova with Conduction Sticker No. EC287A;

That on March 3,2024 around 4:30pm, while about to park at Dennis II Subd., Brgy. 5,
Calamba City I miscalculated the post near gate which resulted to the estimated damaged or
scratch on the right bumper of my car;

That there is no immediate available authority present to investigate the incident’

That I am executing this affidavit for the purpose of attesting to the truth and all the facts
mentioned herein and for all legal intents and purpose.

IN WITNESS WHEREOF, I have hereunto set my hand this 12nd day of March,2024 at
Calamba City.

ZOSIMO GLOR ZARA

Affiant
DL No. D22-12-001254 – 2033/05/11

SUBSCRIBED AND SWORN TO before me this 12nd day of March,2024 at Calamba

City.

WITNESS MY HAND AND SEAL. . . . . . . . . . . . . .

Doc. No. ATTY. RYAN JOSEPH D. IMPROGO

Page No. NOTARY PUBLIC
Book No. CALAMBA CITY,LOS BANOS,BAY,CALAUAN,
Series of 2024 LAGUNA-UNTIL DECEMBER 31, 2025
ROLL NO.73981;NOT NO.16-2022-C
PTR NO.CC 8377063 -01-03-24/CALAMBA CITY
IBP NO.370131/11/23/2023/LAGUNA CHAPTER
MCLE Compliance No. VII-0003252