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Republic of the Philippines)

) S.S.
Done in the City of Baguio)

AFFIDAVIT ACCIDENT

I, EMILIO S. MANGILI, of legal age, Filipino Citizen, married, with residence and
postal address at 157 Bakakeng, Crystal Cave, Baguio City, Philippines, after having been
sworn to in accordance with law depose and state that:

1. On or before September 30, 2015 at about 6:00 o’clock in dusk hour, while I
was driving a TOYOTA/HIACE S. GRANDIA bearing Plate No. YR9518 registered in the
name of my wife JONA M. AGWIKING along Marcos Highway, Tuba, Benguet, enroute to
the direction of Baguio City going down the entrance of road going to Bakakeng, Cyrstal
Cave, Baguio City in a slow moving manner since it is getting dark and I am going down, I
accidentally run over a stone at the middle of the road coupled with slippery pavement
which cause the steering wheel to loss direction;

2. To avoid any further accident, if the vehicle will swerve to the right considering
the upcoming vehicles, I swerved it to the left hitting the parapet and causing damage to
the two (2) WHEEL RIMs (front and back driver side), STEPBOARD and BUMPER of the
vehicle;

3. As a result of the incident, I start the vehicle and brought it home then later I
brought it to the Toyota Baguio City for estimate;

4. I did not report the incident to the police authorities immediately considering
that the accident was caused by a fortuitous event and beyond my control coupled with the
fact that nobody was hurt;

5. I am executing this affidavit to attest to the truth and veracity of its contents and
for all legal intents and purposes that this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 5th day of October
2015, in the City of Baguio, Philippines.

EMILIO S. MANGILI
Affiant
Professional Driver’s License
No. n04-92-250174
Expires on 2016-03-10
LTO Baguio City

SUBSCRIBED AND SWORN, to before me this 5th day of October 2015, in Baguio
City, Philippines, affiant exhibiting to me is Driver’s License as indicated below his name as
proof of his identity.

Doc. No. _____;

Page No. _____;
Book No. ____;
Series of 2015.