AFFIDAVIT OF ACCIDENT

I, ADUL CONCEPCION MARIGA, Filipino, of legal age, single,

with postal and residence addresses at No. 190 J. Munti Brgy.
Poblacion III-A, Imus City, Cavite, Philippines, and B 5 L 6
Dreamville 5 Subd., Carsadang Bago 2, Imus City, Cavite,
Philippines, and upon my oath, do hereby depose and state - That:

1. I am the duly licensed driver with Non-Professional

Driver’s Licensed No. D38-20-000390;

2. Likewise, I am the authorized driver of a motor vehicle

which is more particularly described as follows:

Make YAMAHA
Series MIO GEAR 125
Denomination Without Side Car
Body Type MC
MV File No. 0436-0000084876
Engine No. E32XE-0030280
Plate No. 765 OHN

3. On May 16, 2022, at about 11:27 AM, I was driving with

due care the abovementioned motor vehicle in front of
Petron Gasoline station along Aguinaldo Hi-way, Imus
City, Cavite towards Buhay na Tubig, Imus City, Cavite
when suddenly I was hit and ran by a rampaging motor
vehicle;

4. Due to that accident, I incurred heavy bodily injury and

cause damaged to the aforesaid motor vehicle, (A
photocopy of Medico Legal Report and copies of photo
images of damaged motor vehicle, hereinafter referred
to as Annexes “A” and “B”, respectively;

5. I exerted diligent efforts to immediately inquire and

search for any persons who could personally witnessed
and evidences can help to identify, nevertheless,
fortunately the on-duty gasoline attendants in the place
of accident have their personal knowledge can voluntarily
give their affidavits;

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 6. I am executing this affidavit to attest to the truth of the
foregoing facts and for whatever legal purpose it may
serve.

IN WITNESS WHEREOF, I hereunto affix my signature this

th
18 day of May 2022, Imus City, Cavite, Philippines.

_____________________________________
ADUL CONCEPCION MARIGA
Affiant

SUBSCRIBED AND SWORN to before me this 18th day of May

2022, in Las Piñas City, Metro Manila, Philippines.

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