REPUBLIC OF THE PHILIPPINES)

)S.S.
CITY OF MANILA )

AFFIDAVIT OF ACCIDENT

I, LIANGBO HUANG, of legal age Chinese and resident of 94 Parada Road

City Valenzuela City, after having been duly sworn in accordance with law, depose and
state:

That I am a duly authorized driver of motor vehicles in the Philippines with a

valid and subsisting Driver’s License No. N26-06-021267;

That I was assigned to drive Toyota Fortuner with Plate No.ABQ 3189, and
Serial No. MROGB8DD001315994, and Motor No. 2GD4044558,

It was last Monday July 17, 2017 at around 10:00 A.M. I parked at Sabana St.,
Purok 2 Barangay Consuelo Florida Blanca Pampanga, to pick up some documents,
when I came back about an hour to where my car was park I was surprise because the
front head light, (right side) was already damaged.

That I am executing this affidavit to attest to the truth of all the foregoing
allegations.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________ in

the City of Manila.

LIANGBO HUANG
Affiant

SUBSCRIBED AND SWORN to before me this _________________ in the City

of Manila. affiant exhibited his Driver’s License No. N26-06-021267.

Doc. No. ____;

Page No. ____;
Book No. ____
Series of 2016