Republic of the Philippines )

City of Cagayan de Oro ) Sc.

AFFIDAVIT OF ACCIDENT

I, RICARDO L. SALIGUMBA, of legal age, Filipino, married, and a resident of

Poblacion, Binuangan, Misamis Oriental, after being duly sworn to an oath in accordance with
law, do hereby depose and state that:

1. I am the authorized driver of Toyota Vios, registered in the name of Mark

Anthony M. Agcopra , and with plate number KDN-253.

2. I am a duly licensed professional driver by the Land Transportation Office of

Cagayan de Oro City; my Driver’s license number being KO2-00-081542, issued on June 23, 2005.

3. On June 2, 2007, at or about 2:50 o’clock in the afternoon, I was navigating herein
referred vehicle, on a moderate speed, traversing Lapasan National Highway from Ororama
Mega Center.

4. As I was steering my wheel near intersection of Camp Alagar Road, Lapasan, a

Nissan Ultra Power Pick Up descended from Camp Alagar, suddenly crossed the national
highway without looking at the left portion of where I was traversing, thus causing it to hit the
right front door of my driven vehicle which was severely damaged. It appeared that the driver
alerted his senses to right portion from the secondary road rather than the left side where
approaching vehicles from the city proper were plenty.

5. Despite my effort to evade the ill fated vehicle by altering my movements to the
center lane the collision was inevitable as the driver failed to step upon the brake of his vehicle.

6. This vehicle that hit me bears license plate number KBT-131, and registered under
the name of Benjamin C. Basallo. It was driven at that time by one Ryan D. Basallo;

7. As a result of the accident, the vehicle I was driving sustained damages as follows:

A) The right front door;

B) The right rear door;
C) Scratches on the peripheral portions of the point of impact of the vehicle.
D) Wheel box of the rear tire.

8. I am executing this affidavit in order to attest to the foregoing facts and for whatever
legal purposes it may serve.

IN TRUTH WHEREOF, I have hereunto set my hand this 2 nd day of June 2007 in the City
of Cagayan de Oro.

RICARDO L. SALIGUMBA
Affiant

SUBSCRIBED AND SWORN to before me, this 2nd day of June 2007, at Cagayan de Oro
City; affiant personally appeared to me and exhibited his Professional Driver’s License Number
KO2-00-081542 valid until June 19, 2008, issued on June 23, 2005.

Doc No. 61 RAMIL G. CARREON

Page No. 13 Notary Public
Book No. II Until December 31, 2007
Series of 2007 PTR No.0741738 A, 01.08.2007
IBP No. 693961, 01.08.2007
Roll No. 51523, May 10, 2006
TIN No. 922-710-579