Republic of the
Philippines)
Malolos City, Bulacan ) S.S.
x-------------------------------------x
AFFIDAVIT OF ACCIDENT
I, JOCYLIN LUNARIA ORDOÑEZ, of legal age, single, Filipino,
and with postal address at B40 L5 Ph2 Grand Cedar Homes, Bignay,
Valenzuela City, after having been duly sworn to in accordance with law, do
hereby deposes and states, that:
1. I am the registered owner of a certain motor vehicle with Plate
No. NED 7404, which motor vehicle is more particularly described
as follows, thus:
MAKE: HYUNDAI Engine No.: G4LCKG000245
YEAR MODEL: 2019 MV FILE No. 1366-00000273201
BODY TYPE: SEDAN SERIES: REINA 1.4 GL 4A
2. On September 22, 2022, at 8:00 P.M. or thereabout, I arrived at Acea
Subic Bay Resort, in Subic, Zambales, and thereafter parked my car in
its parking area;
3. On September 24, 2022, after coming back from Zambales, and I
went to a car wash center somewhere in Bignay, Valenzuela City,
while washing my car, the car wash personnel informed me that they
noticed scratches of the whole right side of the motor vehicle,
specifically:
a.) RH QRT PANEL; e.) RH FENDER;
b.) RR BUMPER; f.) HOOD;
c.) RH RR DOOR; g.) RH SIDE MIRROR;
d.) RH FRT DOOR; h.) RH WINDSHIELD POST.
4. May be the above-listed scratches had caused by vandalism at the
parking area of the resort;
5. Also, the car wash personnel have noticed dents in the right side of
the car specifically at RH RUNNING BOARD might have been caused
by the gutter nearby at the Acea Subic, Bay Resort Parking Area,
which I unnoticeably hit while parking my car; and
6. I am executing this Affidavit to attest to the truth of the foregoing
facts and for whatever legal intents and purposes it may serve and for
the insurance purposes of the damaged of motor vehicle and other
related concerns.
2
Malolos City, Bulacan, September 29, 2022.
JOCYLIN LUNARIA ORDOÑEZ
LTO Driver’s Lic. No. N02-19-028250
Affiant
SUBSCRIBED AND SWORN TO before me this 29th day of
September 2022, hereat Malolos City, Bulacan. Affiant personally appeared
exhibiting to me her identification card above-mentioned, known to me and
to me known to be the same person who executed this instrument.
Doc. No. 401;
Page No. 82;
Book No. XXII;
Series of 2022.
