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Affidavit of Accident

Charlimyne G. Intano files an affidavit describing an accident that occurred on November 24, 2020. While parking her 2017 Ford Ranger in Purok 4, Carrascal, debris fell from an ongoing ceiling repair, striking the windshield and causing major cracks. Intano executes the affidavit to attest to the truth of the event, which was beyond her control, for any legal purpose.

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Charlie Joy Intano
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34 views1 page

Affidavit of Accident

Charlimyne G. Intano files an affidavit describing an accident that occurred on November 24, 2020. While parking her 2017 Ford Ranger in Purok 4, Carrascal, debris fell from an ongoing ceiling repair, striking the windshield and causing major cracks. Intano executes the affidavit to attest to the truth of the event, which was beyond her control, for any legal purpose.

Uploaded by

Charlie Joy Intano
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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REPUBLIC OF THE PHILIPPINES)

PROVINCE OF SURIGAO DEL SUR) s.s.


MUNICIPALITY OF CANTILAN)
x--------------------------------------------------/

AFFIDAVIT OF ACCIDENT

I, CHARLIMYNE G. INTANO, Filipino, of legal age, with residence address at PUROK 4


BRGY. BABUYAN, CARRASCAL, SURIGAO DEL SUR, after having been duly sworn to in
accordance with law, hereby, depose and say that:

I am the authorized driver/owner of a vehicle which particularly described as follows:

MAKE AND SERIES : FORD RANGER DOUBLE Hi RIDER WILDTRAK 4X4


MT 3.2L
YEAR MODEL : 2017
MV FILE NUMBER : NONE
PLATE NUMBER : C0G888
ENGINE NUMBER : P5AT2454698
SERIAL/CHASSIS : MNCUMFF50HW734788
COLOR : JET BLACK

On November 24, 2020 at around seven o’ clock in the morning. I was preparing to park the
vehicle in our own parking area at Purok 4 Barangay Babuyan, Carrascal, Surigao del Sur, as I drive the
vehicle heading inside the carport a falling debris from an on-going ceiling repair thumped the
windshield/windscreen of the said vehicle that leads to major cracks. The accident happened so fast and
went beyond my control.

I am executing this affidavit to attest the truth of the foregoing statement and for what legal
purpose this may serve.

CHARLIMYNE G. INTANO
Affiant
Valid ID No: L09-08-000603

SUBSCRIBED AND SWORN to before me this 25th day of November 2020 at Pag-antayan, Cantilan,
Surigao del Sur, Philippines

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