REPUBLIC OF THE PHILIPPINES

BIÑAN CITY, LAGUNA ) S.S.

AFFIDAVIT OF ACCIDENT

I, GORDON G. HICKS, of legal age, Filipino, and resident of Blk 12, Lot 32, Metroville
Complex, Brgy. San Francisco, Biñan City, Laguna after having duly sworn to in accordance
with law hereby deposes and states that:

1. I am the driver of TOYOTA WIGO unit with MV FILE NO. VO-0238 owned by MARK
ERWIN G. HICKS;

2. On or about 03:30 o’clock in the afternoon of September 21, 2018, I parked the
said unit somewhere along the highway of San Pedro City, Laguna and when I am
about to leave the area and veered the unit backwardly facing the road, I
accidentally hit a post;

3. When I inspected the unit afterwards, I found that it sustained damage in the back-
left portion which necessitates restoration or replacement;

4. I hereby execute this Affidavit to attest to the truthfulness of the foregoing facts
and for whatever legal purpose it may serve.

IN WITNESS HEREOF, I have set my hand this 24th day of September 2018, in Biñan
City, Laguna, Philippines.

GORDON G. HICKS
Affiant

SUBSCRIBED AND SWORN to before me, this 24th day of September 2018, in the City
of Biñan, Laguna, by the affiant with ID No. 01-051127369-8.

Notary Public

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