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    Affidavit Vehicular Accident

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    attyjmmalelang17
    Jestoni Roa Evangelio provided an affidavit describing a vehicle accident that occurred on December 23, 2023. According to the affidavit: (1) Jestoni was driving a Toyota Vios owned by Nenita C. Pegi when the accident occurred; (2) the Toyota Vios rear-ended a Mitsubishi Expander that had stopped suddenly upon seeing a barricade; (3) as a result, the Toyota Vios sustained damage to its front portion. Jestoni executed the affidavit to attest to the truth of the circumstances and to report the matter for insurance claims purposes.

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    Affidavit Vehicular Accident

    Uploaded by

    attyjmmalelang17
    46 views2 pages
    Jestoni Roa Evangelio provided an affidavit describing a vehicle accident that occurred on December 23, 2023. According to the affidavit: (1) Jestoni was driving a Toyota Vios owned by Nenita C. Pegi when the accident occurred; (2) the Toyota Vios rear-ended a Mitsubishi Expander that had stopped suddenly upon seeing a barricade; (3) as a result, the Toyota Vios sustained damage to its front portion. Jestoni executed the affidavit to attest to the truth of the circumstances and to report the matter for insurance claims purposes.

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    Jestoni Roa Evangelio provided an affidavit describing a vehicle accident that occurred on December 23, 2023. According to the affidavit: (1) Jestoni was driving a Toyota Vios owned by Nenita C. Pegi when the accident occurred; (2) the Toyota Vios rear-ended a Mitsubishi Expander that had stopped suddenly upon seeing a barricade; (3) as a result, the Toyota Vios sustained damage to its front portion. Jestoni executed the affidavit to attest to the truth of the circumstances and to report the matter for insurance claims purposes.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    46 views2 pages

    Affidavit Vehicular Accident

    Uploaded by

    attyjmmalelang17
    Jestoni Roa Evangelio provided an affidavit describing a vehicle accident that occurred on December 23, 2023. According to the affidavit: (1) Jestoni was driving a Toyota Vios owned by Nenita C. Pegi when the accident occurred; (2) the Toyota Vios rear-ended a Mitsubishi Expander that had stopped suddenly upon seeing a barricade; (3) as a result, the Toyota Vios sustained damage to its front portion. Jestoni executed the affidavit to attest to the truth of the circumstances and to report the matter for insurance claims purposes.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    Republic of the Philippines )

    Butuan City, AND ) s.s.

    AFFIDAVIT

    I, JESTONI ROA EVANGELIO, of legal age, and with residence at Unit 17, CCPG
    Apartment, 3rd Street Extension, Pareja Subdivision, Butuan City, Agusan Del Norte, after having
    been duly sworn to according to law, hereby depose and state that:

    1. I am one of the personnel of Ms Nenita C. Pegi (Nenita) at her pharmacy and the one
    who manages the apartment owned by the latter;

    2. Ms. Nenita C. Pegi is the registered owner of a motor vehicle which is specifically
    described as follows:

    Made : TOYOTA VIOS


    MODEL No. : NSP150LDEXRKM029
    YEAR : 2024
    MOTOR NO. : 1NRY089308
    COLOR : Red Mica Metallic
    PLATE NO. : MV File No. Z7-K731

    3. The said motor vehicle figured in an accident on December 23, 2023, at about 4:02 in
    the morning while I was driving it along Barangay Balangbalang, RTR, Agusan Del
    Norte;

    4. I left my pad on December 23, 2023 to meet a client in Cabdbaran City regarding the
    stocks at the Pharmacy however the client did not arrive. Then, I went home in the
    municipality of Remedio T. Romualdez at around 10 o’ clock in the evening. At around 2
    o’ clock in the morning, I called our family friend to pick up the stocks at Comagascas,
    Cabdbaran City. After we had our coffee, we left and go to Butuan City.

    5. While I was driving going to Butuan City to deliver the stocks of medicines at Ms.
    Nenita’s pharmacy, a Mitsibushi Expander GLX (Expander) is ahead of me, with plate
    number ZAB 4801, owned by Ms. Elsa B. Mejala, and driven by Jeager Dahate Mejala.
    At around 3:55 in the morning, the said Expander suddenly stopped upon belatedly
    seeing a slow-down barricade placed on the road along Soriano, Remedios T.
    Romualdez considering that there is an ongoing Mass or Simbang Gabi (attached hereto
    as Annex “A” is the Traffic Accident Investigation Report);

    6. As a result, the aforesaid Toyota Vios bumped at the rear part of the said Expander and
    thus sustained considerable damage and caused deformity of the front portion of the
    Toyota Vios;

    7. I am executing this affidavit in order to attest the truth of the foregoing circumstances
    and for the purpose of reporting the matter for insurance claims.

    IN WITNESS WHEREOF, I have hereunto set my hands this ___ day of January, 2024
    at the City of Butuan, Agusan Del Norte, Philippines.

    JESTONI ROA EVANGELIO


    Affiant

    SUBSCRIBED AND SWORN to before me this _____ day of January, 2024 affiant
    exhibited to me a competent proof of her identity:

    Name Government Issued ID Valid Until

    JESTONI ROA EVANGELIO

    Notary Public
    Doc. No. _____
    Page No. _____
    Book No. _____
    Series of 2024

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