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    Affidavit of Claim: Marlene D. Quiniquito

    Uploaded by

    Christian Paul Pinote
    Marlene D. Quiniquito owns a 2008 Kawasaki AX125A motorcycle with plate number 6101PC. She lent the motorcycle to her friend Juvie Eslabra Elumba. On April 17, 2009 in Igbaras, Iloilo, a dump truck owned by John Olivares accidentally bumped into the motorcycle driven by Juvie Elumba, who was carrying his mother Trinidad Eslabra y Eslabra on the back. The collision caused Juvie and his mother to be thrown from the motorcycle and sustain fatal injuries. Marlene is executing this affidavit to attest to the details of the accident and waive any claims for damages to her motorcycle.

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    Affidavit of Claim: Marlene D. Quiniquito

    Uploaded by

    Christian Paul Pinote
    34 views1 page
    Marlene D. Quiniquito owns a 2008 Kawasaki AX125A motorcycle with plate number 6101PC. She lent the motorcycle to her friend Juvie Eslabra Elumba. On April 17, 2009 in Igbaras, Iloilo, a dump truck owned by John Olivares accidentally bumped into the motorcycle driven by Juvie Elumba, who was carrying his mother Trinidad Eslabra y Eslabra on the back. The collision caused Juvie and his mother to be thrown from the motorcycle and sustain fatal injuries. Marlene is executing this affidavit to attest to the details of the accident and waive any claims for damages to her motorcycle.

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    Marlene D. Quiniquito owns a 2008 Kawasaki AX125A motorcycle with plate number 6101PC. She lent the motorcycle to her friend Juvie Eslabra Elumba. On April 17, 2009 in Igbaras, Iloilo, a dump truck owned by John Olivares accidentally bumped into the motorcycle driven by Juvie Elumba, who was carrying his mother Trinidad Eslabra y Eslabra on the back. The collision caused Juvie and his mother to be thrown from the motorcycle and sustain fatal injuries. Marlene is executing this affidavit to attest to the details of the accident and waive any claims for damages to her motorcycle.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    34 views1 page

    Affidavit of Claim: Marlene D. Quiniquito

    Uploaded by

    Christian Paul Pinote
    Marlene D. Quiniquito owns a 2008 Kawasaki AX125A motorcycle with plate number 6101PC. She lent the motorcycle to her friend Juvie Eslabra Elumba. On April 17, 2009 in Igbaras, Iloilo, a dump truck owned by John Olivares accidentally bumped into the motorcycle driven by Juvie Elumba, who was carrying his mother Trinidad Eslabra y Eslabra on the back. The collision caused Juvie and his mother to be thrown from the motorcycle and sustain fatal injuries. Marlene is executing this affidavit to attest to the details of the accident and waive any claims for damages to her motorcycle.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 1

    REPUBLIC OF THE PHILIPPINES)

    CITY OF DAVAO . . . . . . . . . . .)S.S.


    X- - - - - - - - - - - - - - - - - - - - X

    AFFIDAVIT OF CLAIM
    I, MARLENE D. QUINIQUITO of legal age, Filipino, and a resident of 22F Salvador
    St., Sta. Lucia, San Juan, Metro Manila, Philippines, after having been duly sworn to in
    accordance with law, do hereby depose and state:
    That I am the registered owner of a certain one unit motor vehicle, particularly described
    as follows:
    Make

    KAWASAKI

    Chassis No.

    AX125A-B04451

    Series

    AX125A

    Model

    2008

    Plate No.

    6101PC

    C.R. No.

    6597184-6

    O.R. No.

    4432183-0

    That the aforementioned motor vehicle was borrowed by my friend JUVIE ESLABRA
    ELUMBA, and it was brought to Brgy. Lumangin Igbaras, IloIlo City,
    That sometimes on April 17, 2009 at Gines St., Brgy. 4 Poblacion of Igbaras Iloilo, the
    dump truck bearing Plate No. GFH-633 owned by John Olivares, accidentally bumped the said
    motor vehicle driven by JUVIE ELUMBA together with him, tandem at the back of motorcycle
    his mother TRINIDAD ELUMBA Y ESLABRA, as a result of accident, the driver of motorcycle
    was thrown away to the center of the road, the victims sustained multiple head and body injuries
    and the driver Juvie Elumba and his mother was rushed by ambulance to Guimbal District
    Hospital for immediate treatment because of seriousness of injuries sustained but pronounced
    DEAD ON ARRIVAL by the attending physician;
    That the said motorcycle incurred un estimated damages on its front fork shock,
    headlight, left and right signal lights, rim, etc.;
    That I am waiving my rights to claim whatever benefits that could extend to my damaged
    motorcycle.
    That I am executing this affidavit to attest to the truth of the foregoing statements, and for
    whatever legal purpose it may serve.
    IN WITNESS WHEREOF, I have hereunto set my signature this _____ day of
    ________________, at _______________, Philippines.

    MARLENE D. QUINIQUITO
    Affiant
    SUBSCRIBED AND SWORN to before me this ________ day of _______________
    2009 at ________________, Philippines.

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