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Affidavit of Incident

Joselito Jaman Blacano provided an affidavit detailing a vehicle accident that occurred on November 29, 2023 while driving a Sinotruk dump truck. According to the affidavit, the truck lost control, veered off the road, and overturned for unknown reasons. Blacano reported the incident to the Kabacan Police Station and executed the affidavit to support an insurance claim for repairs and for any legal purposes. The affidavit included details of Blacano's driver's license and description of the damaged vehicle.

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Nhaz Pasandalan
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135 views

Affidavit of Incident

Joselito Jaman Blacano provided an affidavit detailing a vehicle accident that occurred on November 29, 2023 while driving a Sinotruk dump truck. According to the affidavit, the truck lost control, veered off the road, and overturned for unknown reasons. Blacano reported the incident to the Kabacan Police Station and executed the affidavit to support an insurance claim for repairs and for any legal purposes. The affidavit included details of Blacano's driver's license and description of the damaged vehicle.

Uploaded by

Nhaz Pasandalan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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REPUBLIC OF THE PHILIPPINES )

Arakan, Cotabato ) s.s

AFFIDAVIT OF INCIDENT

I, JOSELITO JAMAN BLACANO, of legal age, Filipino citizen, and resident of Burgos St., Tacurong, Sultan Kudarat,
Philippines, after being duly sworn in accordance with law, hereby depose and state under oath:

1. That I am a holder of a Professional Driver’s License with No. M07-94-005491, valid until November 25,
2026;

2. That at approximately 10:30 AM on November 29, 2023, I was driving a Sinotruk (Dump Truck), owned
and registered in the name of Abdulrauf G. Manalasal towards Brgy. Tamped, Kabacan, Cotabato;

3. That the abovementioned vehicle is more particularly described as follows:

MAKE : SINOTRUK ENGINE NO.: WD61547221207033237

SERIES : HOWO T7 GROSS WEIGHT: 27500

TYPE OF BODY : DUMP TRUCK PLATE NO.: KAE3871

CHASSIS : LZZ5ELSDXPA11143 MV FILE NO. : 1017-00008186692

C.R. No.: 40256872 YEAR MODEL: 2022

4. That on the abovementioned date, time and place, I met an accident wherein due to reasons yet to be
determined, it lost control, veered off the road, and subsequently overturned; and

5. That I reported the said incident at the Kabacan Police Station for record and reference purposes. Copy of
the Traffic Blotter is hereto attached;

6. That I am executing this Affidavit to attest to the truth of the foregoing and in support of the claim from
the insurer for the repair of the damage caused to the said vehicle and for whatever legal purpose or worth it may serve
best.

IN WITNESS WHEREOF, I have hereunto set my hand this 13th day December 2023, in Doroluman, Arakan, Cotabato,
Philippines.

JOSELITO JAMAN BLACANO

Affiant

SUBSCRIBED AND SWORN to before me this 13th day of December 2023 at Doroluman, Arakan, Cotabato,
Philippines, affiant exhibiting competent evidence of identity through Driver’s License ID No. M07-94-005491.

WITNESS MY HAND AND SEAL.

Notary Public

Doc. No. _____;


Page No. _____;
Book No. _____;
Series of 2023.

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