REPUBLIC OF THE PHILIPPINES)

CITY OF PARAÑAQUE )S.S.

AFFIDAVIT OF ACCIDENT

I, SALVADOR V. ABELLANO, of legal age, Filipino, and with

residence address at Blk. 6, Lot 7, Ferrer St., Annex 31, Severina
18, Brgy. Marcelo Green, Parañaque City, after having been sworn
to in accordance with law, hereby depose and say that:

1. I am the owner of the vehicle which is particularly

described as follows:

MAKE: 2020 TOYOTA WIGO

CHASSIS NO.: MKHA4DF5FKJ039450
MOTOR NO.: 1KRA537252
COLOR NO.: ORANGE METALLIC
PLATE NO.: DAZ 7880

2. Yesterday, March 3, 2021 I went to several places. I

arrived in my house at around 9:00pm. I park my car
outside. This morning, I noticed the left tail light of my
car was broken and the back door of the car was dented.
I don’t have any knowledge of who or where did my car
was damaged;

3. I am executing this affidavit to attest to the truth of the

foregoing statement and in support of my claims from the
insurance company.

IN WITNESS WHEREOF, I have hereunto set my hand this 4 th day

of March 2021 in Parañaque City, Philippines.

SALVADOR V. ABELLANO
Affiant

SUBSCRIBED AND SWORN to before me this 4th day of March,

2021 in Parañaque City, Philippines and affiant exhibiting to me his
proof of identification: Driver’s License No. N03-17-013140.

Doc. No. _______

Page No. _______
Book No. _______
Series of 2021.