Republic of the Philippines

PHILIPPINE NATIONAL POLICE

Bamban Police Station
Bamban, Tarlac
August 26, 2022

TRAFFIC ACCIDENT REPORT

NATURE OF THE CASE. RIR to Multiple Physical Injuries and Damaged to Property
TIME/DATE/PLACE. 6:00AM of June 15, 2022 at Bamban-Mabalacat Road, Barangay Lourdes,
Bamban, Tarlac.
VEHICLE INVOLVED. Victory Liner bus with plate number ABC-1234 body number 1235 driven by
ARMANDO CRUZ y David, 45 years old, married, resident of Mawaque resettlement, Mabalacat
Pampanga, holder of professional driver license number AO3-20-135679 valid until 2025 and TOYOTA
Commuter with plate number AC-3345 driven by FERDINAND MADRID y Diaz, 33 years old, single
of Anupul Bamban Tarlac.
VICTIM
1. FERDINAND MADRID y Diaz. 33 years old, single.
2. JULY MIRANDA y Gomez. 23 years old single.
THE INJURED
1. ARMANDO CRUZ y David, 45 years old, married,
2. FERDINAND MADRID y Diaz. 33 years old, single.
3. JULY MIRANDA y Gomez. 23 years old single.
FACTS OF THE CASE. Investigation shows that while the victory liner bus with plate number ABC-
1234 body number 1235 driven by ARMANDO CRUZ y David, 45 years old, married, resident of
Mawaque resettlement, Mabalacat Pampanga, holder of professional driver license number AO3-20-
135679 valid until 2025 was cruising along the Bamban-Mabalacat road and upon reaching the
boundary bridge of Bamban and Mabalacat, the victory liner bus over take the ahead Toyota commuter
with plate number AC-3345 driven by FERDINAND MADRID y Diaz, 33 years old, single of Anupul
Bamban Tarlac but while in progress, sideswiped the Toyota commuter, resulting the latter vehicle to
lose its control and rammed on the railing of the bridge .
ACTION TAKEN. The statements of the victims are taken and taking photograph was also done.
STATUS OF THE CASE. Case in progress.
DRIVERS AFFIDAVIT
DRIVER 1 –VICTORY LINER BUS
Name: ARMANDO CRUZ y David
Address: resident of Mawaque Resettlement, Mabalacat Pampanga
Age: 45 years old, married
Plate number: ABC-1234
Driver license number: AO3-20-135679
Valid up to: This 2025
Facts of the case: on June 15, 2022 at about 6:00am while I was cruising along the Bamban-
Mabalacat road and upon reaching the boundary bridge of Bamban and Mabalacat I over take the ahead
Toyota commuter but while in progress, sideswiped the Toyota commuter, resulting the latter vehicle to
lose its control and rammed on the railing of the bridge .
I hereby certify that above was true and correct and in witness whereof I hereby affixed my
signature above my name this 15th day of June 2022 at Bamban Police Station.
Affiant: Mr. ARMANDO CRUZ y David SUBSCRIBED AND SWORN to before me this 15th day of
June 2022.
DRIVER 2 – TOYOTA COMMUTER
Name: FERDINAND MADRID y Diaz
Address: Anupul Bamban Tarlac
Age: 33 years old, single
Plate number: AC-3345
Facts of the case: While we are cruising along the Bamban-Mabalacat road and upon reaching
the boundary bridge of Bamban and Mabalacat the victory liner bus over take and while in the process
sideswipe us that’s why I loose control and rammed on the railing of the bridge.
Affiant: Mr. FERDINAND MADRID y Diaz SUBSCRIBED AND SWORN to before me this 15th day
of June 2022.

SPO1 CALINGASAN, JOHN LLOYD B.

Administering Officer.
WITNESS AFFIDAVIT
Name: Juan Dela Cruz
Address: Stio. Dungan Brgy. Tabun
Age: A 38 years old
Marital status: Married
Facts of the case:
I Juan Dela Cruz while waiting for the ride to my workplace, I saw the bus overtake then crash
the van and loose its control and rammed on the railing of the bridge.

I hereby certify that above was true and correct and in witness whereof I hereby affixed my
signature above my name this 15th day of June 2022 at Bamban Police Station.
Affiant: Juan Dela Cruz SUBSCRIBED AND SWORN to before me this 15 day of June 2022.

PREPARED BY:
SPO1 CALINGASAN, JOHN LLOYD B.
Investigator of the Case

NOTED BY:
NIXON DULDULAO
Chief of Police