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Affidavit of Driver (VIOLATION)

Xyrenne Gayle Hayahay Lorenzo signed an affidavit stating that on January 2021, she was informed by Alain P. De Leon that his vehicle received a notice of violation for passing through a red light on December 04, 2020 at 1:26:11 pm at G Lazaro, Northbound. In the affidavit, Lorenzo acknowledged that she was driving the vehicle at the specified date, time, and location. She affirmed that she is responsible for any acts committed while driving the vehicle. The affidavit and notice of violation were attached. Lorenzo signed the affidavit to attest to the truth of her statements.

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143 views1 page

Affidavit of Driver (VIOLATION)

Xyrenne Gayle Hayahay Lorenzo signed an affidavit stating that on January 2021, she was informed by Alain P. De Leon that his vehicle received a notice of violation for passing through a red light on December 04, 2020 at 1:26:11 pm at G Lazaro, Northbound. In the affidavit, Lorenzo acknowledged that she was driving the vehicle at the specified date, time, and location. She affirmed that she is responsible for any acts committed while driving the vehicle. The affidavit and notice of violation were attached. Lorenzo signed the affidavit to attest to the truth of her statements.

Uploaded by

Von Baysan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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AFFIDAVIT

I, XYRENNE GAYLE HAYAHAY LORENZO, Filipino of legal age, with


residence at No. 21 Cantillon Street Maysan, Valenzuela City under oath, depose
and say that:

On January 2021, I was made aware by Mr. ALAIN P. DE LEON, registered


owner of [FORD] [2020 EVEREST 2.0L SP] with plate number NGA1639
(hereinafter, the “Subject Vehicle”), that he received a Notice of Violation with
Ordinance Violation Receipt (OVR) Number [OVR Number VX0058742]
(hereinafter, the “Notice”). In the said Notice, the Subject Vehicle allegedly
committed [Sec. 140 (2.b.iii) Passing through the red light] on [December 04,
2020], [01:26:11 pm] at [G Lazaro, Northbound].

On the above-stated date, time and location, I was the one driving the
Subject Vehicle.

I am responsible for any acts or omissions committed during the above-


stated date and time while driving the Subject Vehicle at the specified location.

A copy of the said Notice is attached hereto and made an integral part of
this Affidavit.

I am executing this Affidavit to attest to the truth of the foregoing


statements and for all other legal intents and purposes.

IN WITNESS WHEREOF, I have hereunto set my hand this 20th day of


October 2021 in the Malolos City, Bulacan.

XYRENNE GAYLE HAYAHAY LORENZO


[AFFIANT]

REPUBLIC OF THE PHILIPPINES)


Malolos City, Bulacan) S.S.

SUBSCRIBED AND SWORN to me before this 20th day of OCTOBER 2021,


affiant exhibited his/her UMID with No. 0111-8983412-5 issued by SSS.

Doc. No. _____ ;


Page No. _____ ;
Book No. _____ ;
Series of 2021

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