REPUBLIC OF THE PHILIPPINES )

City of Cagayan De Oro ) SS.

AFFIDAVIT OF ACCIDENT


I, ROMEO MATIBO OCON, of legal age, Filipino, single, and a resident of Bontong,
Camaman-an, Cagayan De Oro City, Misamis Oriental, Philippines, after being sworn
to in accordance with law, depose and state:

1. That on May 20, 2014, at around 4:00 pm, I was driving my motorela bearing
Plate No. MFS-554 along Gaabucayan, St. heading to Agora when suddenly, a
multicab before me, bearing Plate No. MFS-554, suddenly halted without any
signal light whatsoever;
2. That due to the multicabs sudden halt, its rear portion, right part was
accidentally hit by the front portion of the motorela despite me stepping on the
brakes;
3. That the road during that time was wet due to the rain, which made the road
somewhat slippery, making the wheels of the motorela slid forward despite me
timely stepping on the brakes;
4. That the incident and the damage of the motorela took place without any fault or
negligence on my part;
5. That I am executing this Affidavit to attest to the truth of the foregoing facts and
to use the same for insurance purposes.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 1
st
day of JULY
2014 in the City of Cagayan De Oro Philippines.


ROMEO MATIBO OCON
Affiant

JURAT

SUBSCRIBED AND SWORN to before me this 1
st
day of JULY 2014 at Cagayan
De Oro City, Affiant appearing before and personally known to me, exhibiting to me
his Drivers License with Number K02-91-045964, with date of expiration on October
10, 2014.


Doc No. ________;
Page No. _______ ;
Book No. _______;
Series of 2013.