Republic of the Philippines

City of General Santos )S.S.

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AFFIDAVIT OF ACCIDENT

I, JOVE L. COLASITO, of legal age, married, Filipino and a resident of

Gonzales Subdivision, Bula General Santos City, after having been duly sworn to
in accordance with law, depose and state that:

I am a holder a Professional Driver's License Number L07-78-000570 and

the registered owner of a motor vehicle more particularly described below:

MAKE : ISUZU
SERIES : MUX 4 X2 MT LS-M WAGON
ENGINE NO.: 4JK1NL2746
CHASSIS NO.: MPAUCR86GFT009069
PLATE NO. : AAH 9719
COLOR : Silky Pearl White

On or about 6:00 PM on March 3, 2019, I parked the above described

motor vehicle along J. Catolico Ave., Lagao General Santos City for some errands;

Upon returning to my motor vehicle, I was surprised by dents and scratches

at its rear left portion above the rear left tire;

I immediately concluded that the motor vehicle described above was hit-
and-run by unknown motor vehicle; and

I execute this affidavit to attest to the truth of the foregoing and to support
my claim for motor vehicle insurance.

IN WITNESS WHEREOF, I have set my hand this 4 th day of March,

2019 at General Santos City, Philippines.

JOVE L. COLASITO
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this 4th day of March

2019 at General Santos City, affiant being personally known to me.

General Santos City