REPUBLIC OF THE PHILIPPINES)

)S.S.
x---------------------x

AFFIDAVIT OF ACCIDENT

I, NATALIE M. MONCE, of legal age ,Filipino, married and a resident of,

Queensrow West, Bacoor City, Cavite, after being sworn to in accordance with law,
depose and state :

1. That I am duly licensed driver with Driver’s Licensed N26-07-005980, which is

valid until April 26, 2033;

2. That, last August 2023, I parked my car in our school parking lot. When I
checked the car I saw that the upper part trunk area has dent and damaged for
which the said vehicle is more particularly described as follows:

MAKE: TOYATA
SERIES: VIOS 1.3 XLE CV
BODY TYPE: SEDAN
MV FILE NO.: 0401-00001517582
ENGINE NO.: 1NRX797539
PLATE NO.: DAP9559

3. That I am executing this affidavit to attest the truth for the foregoing and in
support of my claim against the insurer for the repair of such damage to the
said vehicle.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of ______,
2023, in the _______________, Philippines.

NATALIE M. MONCE
Affiant
Driver’s License No. N26-
07005980

SUBSCRIBED AND SWORN to before me this _______ day of _____________

2023, in the __________________, Philippines.

Doc. No.
Page No.
Book No.
Series of 2023.