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That I Am The Driver of One TOYOTA INNOVA 2.8J DS With Plate No. HAA 1052 Which Was

Rodrigo Pelaez Beronio, a resident of Brgy. Maslog, Tomas Oppus, Southern Leyte, Philippines, was driving his son Kurt R. Beronio's 2016 Toyota Innova when he had an accident on December 31, 2019 along the Barangay Road in San Isidro, Tomas Oppus. While maneuvering the vehicle after hitting a rock that caused damage to the front bumper, he accidentally hit a small tree and "Gemelina Tree", scratching the side of the car. No one was injured. He executed this affidavit to attest to the truth of the incident and to support an insurance claim for the damaged vehicle.

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Don Sala
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64 views1 page

That I Am The Driver of One TOYOTA INNOVA 2.8J DS With Plate No. HAA 1052 Which Was

Rodrigo Pelaez Beronio, a resident of Brgy. Maslog, Tomas Oppus, Southern Leyte, Philippines, was driving his son Kurt R. Beronio's 2016 Toyota Innova when he had an accident on December 31, 2019 along the Barangay Road in San Isidro, Tomas Oppus. While maneuvering the vehicle after hitting a rock that caused damage to the front bumper, he accidentally hit a small tree and "Gemelina Tree", scratching the side of the car. No one was injured. He executed this affidavit to attest to the truth of the incident and to support an insurance claim for the damaged vehicle.

Uploaded by

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

Province of Southern Leyte ) S.S.


Municipality of Tomas Oppus)

DRIVER’S AFFIDAVIT

I, RODGRIGO PELAEZ BERONIO, Filipino, of legal age, married and a resident of Brgy. Maslog,
Tomas Oppus, Southern Leyte, after having been duly sworn in accordance with law, hereby depose and say:

1. That I am the driver of one TOYOTA INNOVA 2.8J DS with Plate No. HAA 1052 which was
entrusted to me by my son KURT R. BERONIO who is the owner of the said car more particularly
described as follows:

MV File No. 0801-00000069160


Engine No. 1GD0165882
Chassis No. PA2CA8EM2G0006932
Make: TOYOTA
Body Type: Wagon
Year Model: 2016

2. That on December 31, 2019 at about 9:00 AM, while I was driving along the Barangay Road going to
the IFI Cemetery in San Isidro, Tomas Oppus, Southern Leyte, I accidentally hit a rock that caused dent
of about 5 inches deep and 8 inches in diameter to the right part of the front bumper and deep
scratches around it, To my dismay, I immediately check the damage and decided to transfer the car to
another place but while maneuvering it hit a small tree and accidentally bumped a “Gemelina
Tree”causing scratches beginning at the right portion of the front door all the way to the rear of
the car and two deep scratch at the rear bumper of about 3 inches in length;

3. That no person was injured in the above-cited incident;

4. That I executed this affidavit in order to attest to the truth and veracity of the foregoing and in order to
support our claim for the insurance proceeds of the said vehicle and for whatever legal intents and
purposes this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 31st day of December 2019 at Tomas
Oppus, Southern Leyte Philippines.

RODGRIGO PELAEZ BERONIO


Affiant
(Driver’s License: H05-09-000694)

SUBSCRIBED AND SWORN to before me this 31st day of December 2019 at Tomas Oppus, Southern
Leyte Philippines.

Atty. DON VALDE SALA


NOTARY PUBLIC FOR THE PROVINCE
OF SOUTHERN LEYTE
Doc. No. 398 Commission Control No. 2018-10; Until Dec. 31, 2019
Page No. 81 Roll No. 70454
Book No. VI IBP OR No. 058141; 12/28/2018
Series of 2019. PTR No. 6590660; 12/20/2018
MCLE Compliance No. 0027850

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