REPUBLIC OF THE PHILIPPINES )

CITY DASMARINAS. . . . . . . ) S.S.

PROVINCE OF CAVITE

A F F I D A V I T OF ACCIDENT

I, RAFAEL E. RUDIO, Filipino, of legal age, and a resident of B5 L1 Brgy. San

Miguel 2, Dasmarias City, Cavite, after being duly sworn to in accordance with
law, depose and state: That - -

1. I am the authorize driver of ORLANDO E. CORTEZ, who is the

registered owner of a motor vehicle particularly described as follows:

MAKE : MITSUBISHI
SERIES : MIRAGE
ENGINE NO. : 3A92UDK3150
CHASSIS NO. : MMBXNA03AGH017776
COND. STICKER : NP7107

2. Unfortunately, on 16th of October 2016, at around 8:00 a.m, I discovered

that while the above vehicle was parked at my friends house at Pasay
City, it was sideswipe by an unknown vehicle;

3. The incident was out of my knowledge because I was sleeping at my

friends house and just discovered it in the morning after.

4. On account of said accident, the left side of the vehicle was damage;

5. Further, I hereby declare under oath that I exerted sincere efforts to

ascertain who and what caused the above-mentioned damages but to no
avail;

6. I am executing this affidavit to attest to the truth and veracity if the

foregoing statements and for whatever legal purpose the same may serve;

IN WITNESS WHEREOF, I have hereunto affixed my signature this 4th day

of November 2016 in Dasmarias City, Cavite.

RAFAEL E. RUDIO
Affiant

SUBSCRIBED AND SWORN to before me this 4th day of November 2016

affiant exhibiting to me his Driver License No. D18-14-000738.

Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2016