AFFIDAVIT OF ACCIDENT

I, CRESCINI ARCILLA LUNGCAY, Filipino citizen, of legal age,

single, with postal and residence addresses at No. 287 Brgy. Santol,
Tanza, Cavite, Philippines, having duly sworn in accordance with
law, do hereby depose and state, that:

1. I am the duly licensed driver with Non-Professional

Driver’s License No. D06-19-019980;

2. Likewise, I am the authorized driver of a motor vehicle

registered under MANG INASAL PHILIPPINES, INC.,
which is more particularly described as follows:

Certificate of Registration 345543391

Make Mitsubishi
Series Xpander GLX PLU
Body Type Wagon
MV File No. 1324-00000796570
Engine No. 4A91GT5091
Plate No. NEF1976

3. On May 25, 2022, at about 9:28 AM, I was driving with

due care the abovementioned motor vehicle along
Aguinaldo Highway near Robinson Imus, going to City
Mall Imus City, Cavite, when I was suddenly hit and ran
by a motorcycle;

4. I have no bodily injury however, due to that accident

causes dents on the rear door and scratches on the right
side portion of the aforesaid motor vehicle, (A copy of
photo image of damaged motor vehicle, hereinafter
referred to as Annex “A”;

5. 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

th
25 day of May 2022, Imus City, Cavite, Philippines.

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 _____________________________________
CRESCINI ARCILLA LUNGCAY
Affiant

SUBSCRIBED AND SWORN to before me this 25th day of May

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

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