Republic of the Philippines}

City of Davao}S.S.

AFFIDAVIT OF VEHICULAR ACCIDENT

I, _______, of legal age, Filipino, single, and a resident of Davao City,

Philippines after being sworn to in accordance with law, do hereby depose and state
THAT:

1. I am the holder of a Professional Driver’s License No. l02-14-

0106469875486753E issued by the Land Transportation Office and valid until October
18, 2016;

2. I am the driver of a Mitsubishi Montero with plate number hALA 1000

registered under the name of Francis Ayuste Pe. Benito;

3. On September 3, 2015, around ten o’clock in the morning, I was driving

the above-mentioned vehicle along J.P. Laurel Ave.;

4. I was about to make a U-turn along J.P. Laurel Ave. near SM Lanang
Premier in order to go to Sasa, Davao City;

5. While I was executing the U-turn, a motorcycle suddenly appeared on the

left side of the vehicle I was driving, as if ignoring the turn I was executing. Thus, I was
not able to prevent a collision with the said motorcycle since the vehicle I was driving
was already in the middle of executing a U-turn;

6. After the collision, the driver of the motorcycle stood up and drove away
on his motorcycle;

7. The aforementioned situation was an accident beyond my control even

after exercising extraordinary care and diligence;

8. I am executing this affidavit to attest to the truth of the foregoing facts.

IN WITNESS WHEREOF, I have hereunto set my hand this 4th day of September
2015 in Davao City, Philippines.

____
Affiant

SUBSCRIBED AND SWORN to before me this 4 th day of September 2015 in

Davao City. Affiant had exhibited to me his Driver’s License No. L02-14-0106469875.

Doc. No. __________

Page No. _________
Book No. _________
Series of 2015.