Republic of the Philippines )

Province of Davao del Sur ) S.S

City of Digos )
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AFFIDAVIT OF VEHICULAR ACCIDENT

I, RODERICK RALOTA MILANA, of legal age, Filipino, married and
a resident of Digos City, Davao del Sur Philippines, upon duly sworn to in
accordance with law, hereby depose and state, THAT:

1. I am the same and identical person who executed this instrument;

2. I am the registered owner of a TOYOTA vehicle which is particularly

described as follows:

Engine No. : 1KRA492941

Plate No. : CS POX362
C. R. NO. : 349132405
O.R. No. : 1613065893

3. On February 12, 2020, while I was driving backward in my parking lot,

I accidentally hit the gate of my residence because of strong winds which caused
damage to my tail light and minor misalignment of my left side rear bumper;

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

in order to apprise the proper authorities of the said facts and for whatever legal
purpose this may serve best.

IN TESTIMONY THEREOF, I have hereunto affixed my signature this

__________________ at Digos City, Davao del Sur, Philippines.

RODERICK RALOTA MILANA

Affiant
L03-83-005001

SUBSCRIBED AND SWORN to before me this _______________ at

Digos City, Davao del Sur, Philippines.

Doc. No. : _______;

Page No. : _______;
Book No. : _______;
Series of 2020.