REPUBLIC OF THE PHILIPPINES)

CITY OF BATANGAS )SS.

AFFIDAVIT OF ACCIDENT
I, RENATO MATEO, of legal age, Filipino citizen and a resident
of044B Evangelista St., Santolan, Pasig City, after having duly sworn
in accordance with law hereby deposes and states that:

1. I am the authorized driver of a vehicle registered in the name of

my employer, JANE A. CASAS, more particularly described as
follows:

Make : TOYOTA
Engine No. : 2GD8184224
Chassis No. : MRDGB8DD6H1409051
Body Type : PICK-UP
Series : HILUX 2.4L 4X2
Year Model : 2017
Conduction Sticker No. : WJO 859
Plate No. : A0P004

2. Moreover, on July 19, 2018, I parked the said motor vehiclealong

the Diversion Roadand left it for about an hour since I will be
having my dinner at Ciudad Food Park. Upon my return, I was
surprised when the said vehicle already had several damages on
the right side of the front and back door and also on the carrier of
the vehicle. Nobody was able to reveal the cause of the said
dent/damages;

3. The said vehicle is covered by an insurance policy of Alpha

Insurance & Surety Co., Inc.with Policy No. PC-B2-101073/17,
period covered from July 26, 2017 to July 26, 2018

4. I am executing this Affidavit to attest to the truth of the

foregoing, for the purpose of informing the insurer of such
occurrence and further, for whatever legal purpose this may
serve.

FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto affixed my signature

this July 20,2018 at Batangas City.

RENATO MATEO
Affiant

SUBSCRIBED AND SWORN to before me in the City of

Batangas this 20thof July 2018 by the Affiant who exhibiting to me his
____________________.

Doc. No.343A;
Page No.70;
Book No.XX;
Series of 2018.