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Affidavit of Car Accident

1. Myra Saez Gumacal files an affidavit stating that on June 11, 2023 at 4:30pm in the intersection of Dahlia Avenue and Magnolia Street in Quezon City, a motorcycle accidentally hit the left side of her Mitsubishi Xpander, damaging her side mirror, causing scratches and dents. 2. Myra Saez Gumacal files a second affidavit stating that on July 15, 2023 at 11:30pm while entering her gate in heavy rain and dark conditions, she accidentally bumped her Toyota Innova, damaging the front left side. 3. Both affidavits were signed and notarized in Quezon City, Philippines

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90 views2 pages

Affidavit of Car Accident

1. Myra Saez Gumacal files an affidavit stating that on June 11, 2023 at 4:30pm in the intersection of Dahlia Avenue and Magnolia Street in Quezon City, a motorcycle accidentally hit the left side of her Mitsubishi Xpander, damaging her side mirror, causing scratches and dents. 2. Myra Saez Gumacal files a second affidavit stating that on July 15, 2023 at 11:30pm while entering her gate in heavy rain and dark conditions, she accidentally bumped her Toyota Innova, damaging the front left side. 3. Both affidavits were signed and notarized in Quezon City, Philippines

Uploaded by

Rudolf
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 DOC, PDF, TXT or read online on Scribd
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REPUBLIC OF THE PHILIPPINES )

QUEZON CITY ) S.S.

AFFIDAVIT OF ACCIDENT

I, MYRA SAEZ GUMACAL, of legal age, Filipino, with address at L39 B4


PINE ST. WEST FAIRVIEW PARK SUBD., QUEZON CITY, after having been duly
sworn to in accordance with law, hereby depose and say that:

That I am the Owner of MITSUBISHI XPANDER with Plate No. NCS 1920,
GLS 1.5 2WD AT WAGON and with CONDUCTION Sticker B41419;

That last June 11, 2023 at around 4:30 pm, when I was moving in the
intersection of Dahlia Avenue Corner Magnolia Street, Fairview, Quezon City, the
motorcycle accidently hit on my vehicle at the left-side driver area causing my
side mirror damage, scratches and dents below.

That I am executing this affidavit in order to attest the truth of the


foregoing facts and for all legal intents it may serve.

IN WITNESS WHEREOF, I have signed this instrument this 13th day of


June 2023 at Quezon City, Philippines.

MARIA TERESA LASOLA MATIAS


Affiant

SUBSCRIBED AND SWORN to before me this 13th day of June 2023


at Quezon City, Philippines. Affiant exhibiting his CTC No. ________ issued on
_________ at ______________

Doc. No.: _____________ NOTARY PUBLIC


Page No.: _____________
Book No.: _____________
Series of 2023
REPUBLIC OF THE PHILIPPINES )
QUEZON CITY ) S.S.

AFFIDAVIT OF ACCIDENT

I, MYRA SAEZ GUMACAL, of legal age, Filipino, with address at L39 B4


PINE ST. WEST FAIRVIEW PARK SUBD., QUEZON CITY, after having been duly
sworn to in accordance with law, hereby depose and say that:

That I am the Owner of TOYOTA INNOVA 2.8E DI with Plate No. NET6023,
Body Type WAGON and with ENGINE NO. 1GD1015650;

That Last Night July 15,2023 at around 11:30 pm, when I was moving
forward to enter our gate, I accidentally bumped it due to dark hallway and
heavy rain, causing the front left side of my car damaged.

That I am executing this affidavit in order to attest the truth of the


foregoing facts and for all legal intents it may serve.

IN WITNESS WHEREOF, I have signed this instrument this 15th day of


July 2023 at Quezon City, Philippines.

MYRA SAEZ GUMACAL


Affiant

SUBSCRIBED AND SWORN to before me this 15th day of July 2023


at Quezon City, Philippines. Affiant exhibiting his CTC No. ________ issued on
_________ at ______________

Doc. No.: _____________ NOTARY PUBLIC


Page No.: _____________
Book No.: _____________
Series of 2023

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