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Affidavit-car-Accident - JOSE MIGUEL L. ABIERA

Jose Miguel L. Abiera filed an affidavit stating that on February 4, 2023, he noticed a flying object hit the rear glass window of his 2017 Chevrolet sedan. Upon inspection, he saw the rear glass was broken with several cracks. He believes a person may have thrown a stone hitting the rear portion of his vehicle. He signed the affidavit on February 6, 2023 in Sibulan, Negros Oriental, Philippines to attest to the truthfulness of his statements regarding the accident.

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RJ Banquerigo
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64 views1 page

Affidavit-car-Accident - JOSE MIGUEL L. ABIERA

Jose Miguel L. Abiera filed an affidavit stating that on February 4, 2023, he noticed a flying object hit the rear glass window of his 2017 Chevrolet sedan. Upon inspection, he saw the rear glass was broken with several cracks. He believes a person may have thrown a stone hitting the rear portion of his vehicle. He signed the affidavit on February 6, 2023 in Sibulan, Negros Oriental, Philippines to attest to the truthfulness of his statements regarding the accident.

Uploaded by

RJ Banquerigo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Republic of the Philippines)

Province of Negros Oriental)s.s.


Municipality of Sibulan.…)

AFFIDAVIT ON AN ACCIDENT

I, JOSE MIGUEL L. ABIERA, married, of legal age, Filipino, and a resident of


Bagacay, Dumaguete City, Negros Oriental, after having been sworn to in accordance
with law, do hereby depose and state that:

I am the registered owner of one (1) motor vehicle, which is more particularly
described as follows:

MAKE: CHEVROLET ENGINE NO.:


LEW*163343494*
BODY TYPE: SEDAN C.R. NO.: 252438373
CHASSIS NO.: LSGHD528XGD257858 YEAR MODEL: 2017
MV FILE NO.: 0701-00000489802

That on February 4, 2023, I noticed that a flying object hit the rear glass window
of the above-mentioned vehicle. Perhaps, a person threw a stone on the rear portion of the
said vehicle;

After the incident, I noticed that the rear glass of the above-mentioned vehicle
was broken with several cracks.

That this affidavit is executed freely and voluntarily to attest the veracity and
truthfulness of my statements herein.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 6 th day of


February 2023 in Sibulan, Negros Oriental, Philippines.

JOSE MIGUEL L. ABIERA


Affiant

SUBSCRIBED AND SWORN to before me, a Notary Public, on this 6 th day of


February 2023 for the Municipality of Sibulan and the Province of Negros Oriental,
Philippines, the above-named affiant, exhibited his PRC ID No. 0556503 valid until
05/10/2024, and WHO SIGNED IN MY PRESENCE the foregoing document
(AFFIDAVIT ON AN ACCIDENT), and who avows under PENALTY OF LAW to the
whole truth of the contents of the same.

Doc No. 83;


Page No. 18;
Book No. I;
Series of 2022.

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