REPUBLIC OF THE PHILIPPINES

PHILIPPINE NATIONAL POLICE

TRAFFIC ACCIDENT INVESTIGATION FORM

FILE NO.001135

I. WHERE:
Km.5 , Near Metrobank Buhangin , Davao City

II. WHEN:
11 May 2017

III. WHAT:
Vehicle vs. Another vehicle

TYPE OF ACCIDENT: Property Damage

IV. HOW:
Angle

V. VEHICLE Number of vehicles involved

Vehicle 1 Vehicle2
Type : Private Utility Vehicle Private Utility Vehicle
Make and Model: Montero Honda Pit
Plt no. Decal no: LHR5543 LIY7191
Classification: Private Private
Driven by: Kale Bangon Cole Langot
Occupation: Floor Manager Stock Broker
Drive Lic. No: WAN-66-010514 NVM-69-787999
Nationality: Filipino Filipino
Age: 43 yrs old 38 yrs old
Sex & Status: Married Separated
Vehicle Owner: Paul Lu Cole Langot
Address: Sasa , Davao City Toril
Reg. Cert Nr: 655-63165 185-78137
Estimated Damage: ₱ 3,700
 TRAFFIC ACCIDENTAL INVESTIGATION REPORT

An accident happened at km5 , just in front of Metrobank Buhangin, Davao City , on 11th
of May 2017 at around 9am. A Honda Pit was maintaining speed of 30-35 kph coming from
the direction of Orange Groove Hotel ,Buhangin Crossing/Junction, Driven by Cole Langot ,
with a plate number of LIY7191, was hit on the right side coming from Pag-asa street.
A Montero , Driven by Kale Bangon with a plate number of LHR5543, running with a speed
of 45-50 kph. There were no injured persons , only damages of property.

Base on the Interview from both sides , Mr. Cole Langot was driving properly , when he was
suddenly hit , he started to panic for he might hit some pedestrians , he then realized that he
was hit by a Montero from the right side of the vehicle. While from Mr. Kale Bangon’s
testimony was he didn’t see a vehicle coming from the left of his side so he then proceeded ,
that was the moment he didn’t know he was over speeding from a roadway , while using a
Smartphone. He also didn’t suffer any injuries.

VI. ACTIONS TAKEN:

Awaiting both sides for filing of complaints to conduct further investigations to
provide more evidences.

VII. STATUS OF CASE:

On-going

VIII. REPORTED BY:

Frangos, Lois Adrian P.