Republic of the Philippines)

City of Panabo…………………) S.S

X----------------------------------------X

AFFIDAVIT

I, NOVIE GAFATE JALME, of legal age, Filipino, single, and a resident

of Purok 1, Brgy. San Francisco, Panabo City, Davao del Norte, Philippines,
after having been duly sworn to in accordance with law, do hereby depose
and say THAT:

1. I am the driver of TOYOTA VIOS SEDAN (Black) registered under the

name of KIYOUNG-KIM, with OR No. 1779918151, issued on 12-03-2019, bearing
plate no. ACS 5360;

2. On February 2, 2020, at 9:00PM, the above-mentioned vehicle

figured an accident at intersection of Maharlika road and Roxas St., Purok
Alugbati, Brgy. Gredu, Panabo City, attached is a copy of Traffic Accident
Investigation Report (TAIR);

3. The accident involved a KAWASAKI CT100 MC (Black), bearing MV

File No. 1101-0112595, driven by one ROBERT DACULO, 22 years old, male,
single, and a resident of Matina Pangi, Davao City;

4. The said KAWASAKI CT100 MC (Black) driven by ROBERT DACULO

suddenly collided the front part of my vehicle at undetermined speed while
I was at halt to make a left turn;

5. As a result of the accident, my vehicle sustained undetermined

damage that needs repair or replacement, if the former is not possible;

6. I am executing this Affidavit to apprise the authorities

concerned on the veracity of the foregoing facts and for the purpose of
retrieving my PDL card with number M07-19-004879 from authorities.

IN WITNESS WHEREOF, I have set my hand this 3rd day of February, 2020,
at Panabo City, Davao del Norte, Philippines.

NOVIE GAFATE JALME

Affiant
CEI:

SUBCRIBED AND SWORN to before me this 3rd day of February, 2020, at

Panabo City, Davao del Norte, Philippines, affiant exhibited to me her
competent evidence of identity as shown above.

Doc. No.:_____
Page No.:_____
Book No.:_____
Series of 2020.