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AFFIDAVIT OF INCIDENT
Make : Toyota
Type : SUV
Model : 2017 Fortuner V, 4X2, A/T, Attitude black
Engine Number : 2343433555094115
Conduction Sticker Number: AGA3432
MV File No.: 1301-0ASDFASDF904
Plate Number: not yet issued
4. I immediately hazard my motor vehicle, and stopped right after the C-5
toll gate to check on my wind shield;
Subscribed and sworn to before me this 23rd day of November 2018 at City
of Sta. Rosa, Laguna, Affiant exhibited to me her Driver’s License Number
____________, issued on ______________at
______________________________, with expiration period of
_________________.