INCIDENT REPORT

I, Evangeline M. Gutierrez, of legal age, Filipino, and a resident of

Tutuban 2, Brgy. San Roque, Gapan City, Nueva Ecija, after having been
duly sworn to in accordance with law, do hereby deposes and states that
last January 6, 2020, at around 7:00 in the evening, after attending to
an important meeting at Edgardo’s Café, Vergara Bypass Rd., Brgy. Sta
Arcadia, Cabanatuan City, Nueva Ecija, the driver, Mr. Arnel
Constantino, operating the vehicle, a 2019 Toyota Fortuner with Plate
No. CAT 1201, reversely maneuvered the vehicle towards the direction
going to San Leonardo bypass road, when suddenly a huge pile boulder
was unintentionally rammed by the vehicle, upon advancing towards the
direction going to San Leonardo, which went under the vehicle which
caused deep scratches, as well as dents, in the lower portion of the
bumper of the vehicle. I am writing this Incident Report to inform the
proper authorities of the accident that took place involving my vehicle,
and further make a recommendation that an investigation regarding the
said incident be made for purposes of indemnification.

Respectfully yours,

EVANGELINE M. GUTIERREZ
Affiant