1.

This is not a detailed statement of the incident that happened

on the aforesaid date and time, and I am willing to testify in
any forum to amplify my statement.

IN WITNESS WHEREOF, I have hereunto set my hand this

___th day of July, 2015.

____________, Affiant/Complainant

1.
2.
3. subpoena at his residence at #69 Military Cut - Off, Baguio
City.

REPUBLIC OF THE PHILIPPINES )

) SS.
IN THE CITY OF BAGUIO )

COMPLAINT AFFIDAVIT

I, ____________, of legal age, married, and presently residing

at #4 Purok II, Bakakeng Sur, Baguio City, on oath, depose and say
that:

4. I am filing a case of reckless imprudence resulting to damage

to property against Mr. Nelson Nagsagaray y Bermudez, 46
years old, married, and may be served subpoena at his
residence at #69 Military Cut - Off, Baguio City.

5. When I alighted from my vehicle to see the damage that was

caused to my vehicle I was shocked to see that the bumper on
the left side of my vehicle was disfigured by such impact.

6. On July 12, 2015, at around 5:00 in the afternoon I parked my

Isuzu Crosswind bearing license plate number UJI - 299 on
the right side of the main road or just beside the Satellite
Market to purchase vegetables and “pasalubong”. After
making my purchases, I then started to embark from the said
place.

7. An estimate of the cost of the repair of my vehicle was made

by Robert’s Auto Repair Shop and Parts, which based on their
estimate shall cost ____________,.
 1.
2. I am filing a case of reckless imprudence resulting to damage
to property against Mr. Nelson Nagsagaray y Bermudez, 46
years old, married, and may be served subpoena at his
residence at #69 Military Cut - Off, Baguio City.

3. When I checked the vehicles on my rear and saw that a

vehicle, which came from the city proper, was about to turn left
to a driveway it caused all other vehicles at its rear to a full
stop. Since the lane was open and no vehicle was passing
through, it prompted me to move my vehicle to towards the
road.

4. When I was slowly moving forward to traverse the lane

towards Kenon Road, an Isuzu Crosswind taxi bearing license
plate number ____________, being driven by Mr.
____________, ____________, y ____________, bumped
the vehicle that I was driving.

SUBSCRIBED AND SWORN to before me this ___th day of

July, 2015; I certify that I have personally examined the affiant-
complainant and that I am satisfied that she voluntarily executed her
Complaint Affidavit and understood the same.