Republic of the Philippines )

City of Malolos, Bulacan ) S.S.

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COMPLAINT AFFIDAVIT

I, IEUAN LISING, 17 years old, herein assisted by my mother, RIFFY MAE ANN
GARADOS – LISING, of legal age, married and both residence of no. 003 San Juanico
St., San Agustin, Malolos City, Bulacan, after having been duly sworn to in accordance
with law, hereby depose and state that:

1. That on April 5, 2018 at around 4:00 in the morning, the undersigned was
walking along the road side of Paseo Del Congreso, heading westbound, going to
Malolos Public Market, purposely to buy things for our carinderia business;

2. Suddenly, a motorcycle with sidecar driven by a certain BILL JOHN

SUBILLAGA was moving recklessly by swerving from left and right of the road at an
accelerated speed;

3. At that juncture, the driver of the said motorcycle lose its control and
bumped from a concrete post where the undersigned was presently positioned;

4. As a result, the victim and/or the undersigned sustained serious injuries

and immediately brought before the Bulacan Medical Center for medical treatment;
(Pictures of the victim are hereto attached as “ANNEX-A”)

5. Meanwhile, the said incident was initially reported at Malolos City Police
Station who conducted investigation; (Traffic Investigation Report is hereto attached as
“ANNEX-B”)

6. That on April 6, 2018, Dr. Protacio Galagala, who conducted Physical

Examination disclosed that the undersigned sustained multiple fragmentation on left leg
and visual impairment on the left eye; (Physical Examination Result is hereto attached
as “ANNEX-C”)

7. Per investigation conducted by P03 Cardo Dalisay of Malolos Police

Station revealed that the driver of the said Motorcycle failed to show his driver’s license
and the said Motorcycle was delinquently registered;

8. Likewise, Breath Alcohol Test conducted to Mr. Subillaga by Dr. Jamsen

Mispah revealed the presence of alcohol and similar substance. Thus, suspect is
intoxicated; (Alcohol Test Result is hereto attached as “ANNEX-D”)
 9. That the victim and/or the undersigned sustained serious injuries and
referred to undergo bone fixture and rehabilitation for the duration of three (3) months
and Optal Check-up and rehabilitation for three (3) months;

10. That the estimated cost of medical expenditure amounted to sixty

thousand pesos (P60,000.00) inclusive of medicine and surgical equipment’s; (Medical
Expenses/Receipts are hereto attached as “ANNEX-E”)

11. I am executing this affidavit to attest to the truth of the foregoing facts and
to support the filing of case against one (1) BILL JOHN SUBILLAGA for all the
infractions of law and shall be punished accordingly.

IN WITNESS WHEREOF, I have hereunto set my hand this 23rd day of April 2018
at Malolos City, Bulacan.

IEUAN LISING
Affiant

Assisted by:

RIFFY MAE ANN GARADOS - LISING

SUBSCRIBED AND SWORN to before me this 23rd day of April 2018 at Malolos
City, Bulacan. I FURTHER CERTIFY that I have personally examined herein affiant and
that I am fully satisfied that they voluntarily executed and understood the contents
thereof.

__________________________
(Administering Officer)