Del Rosario, Ronnie G.

Legal Writing I
October 1, 2019

AFFIDAVIT OF DAMAGE TO VEHICLE

I, MARU PAMARAN POCSIA, a Filipino citizen, of legal age,

and a resident of Dalipaoen, Naguilian, La Union, Philippines, after
having been sworn to in accordance with law, do hereby depose and
state:

1. That I am a duly licensed driver with Driver’s License No. A04-

19-881234 valid until March 13, 2023;

2. That on September 27, 2019, at around 5:30 in the afternoon,

on my way to Rose Bowl Bauang, La Union, I was traversing a
traffic along Bauang Public Market driving my motor vehicle
particularly described as follows:

Make: Toyota
Series: Vios G
Body Type: Sedan
Motor No.: M2019DGL3717888
Chassis No.: C2019GG125MR0713
Year Model: 2019
Color: Black Mica Metallic
Plate No.: MPO 5555
MV File No.: 0101-0000001234567

3. That my motor vehicle was bumped by a Mitsubishi Montero

GLX 4X2 which is particularly described as follows:

Make: Mitsubishi
Series: Montero GLX 4x2
Body Type: Sport Utility Vehicle
Motor No.: M2016ANR0307217
Chassis No.: C2016DM313R1229
Year Model: 2016
Color: Black
Plate No.: No Plate Available
MV File No.: 0101-000000333333

4. That the said Mitsubishi Montero vehicle has an expired

registration and being driven by Mr. Dominador Mabalin
Amin, who was apparently drunk, and a holder of an expired
driver’s license with License Number N13-16-666555;

5. That Mr. Amin was driving fast along the shoulder of my lane.
Suddenly, he swerved into my lane and tried to insert between
my vehicle and the truck behind me, because there was a
Del Rosario, Ronnie G. Legal Writing I
October 1, 2019

tricycle parked along the shoulder. As a result, he bumped into

my vehicle from the back, and due to strong impact, my vehicle
was forcibly pushed and bumped into a motorcycle in front;

6. That my vehicle’s rear bumper was removed, its compartment

was badly dented, and its right rear light was broken. Its front
bumper also had a big scratch;

7. That Mr. Amin, tried to drive away but was stopped by a police
officer;

8. That the total repair cost of my car estimated by Toyota La

Union is Fifty Two Thousand Eight Hundred Fifty Pesos (Php
52,850.00);

9. That the incident was already reported to Bauang Municipal

Police Station, Bauang, La Union;

10. That I am executing this affidavit to attest to the truth of the

foregoing statements and further support the claim with the
insurance company for the repair of the damages of my car,
and other purposes it may deem serve.

IN WITNESS WHEREOF, I hereunto affixed my signature this

1 day of October, 2019 at City of San Fernando, La Union,
st

Philippines.

MARU P. POCSIA
Affiant