8/17/2019 Affidavit of Accident - Bon

1/2

Republic of the Philippines) S.S.City of Quezon)x--------------------------------------x

 A F F I D A V I T

I, REYNI D. !D"!N#$!Y!N, %ilipino, of le&'l '&e,('ie*, 'n* ' esi*ent of ++ inni' St., nite*,P''n'/ue City, 'fte bein& *uly s0on in 'cco*'nce 0ithl'0, heeby *epose 'n* st'te1

+. 2h't I '( the *uly license* *i3e 0ith Non-Pofession'l Di3e4s "icense No. N56-7-8879, 0hich is

 3'li* until 'ch +:, :8+.

:. 2h't on !pil +;, :8+

8/17/2019 Affidavit of Accident - Bon

2/2

IN GI2NESS GAERE5%, I h'3e heeunto set (y h'n*this :8th *'y of !pil, :8+< 't City of Quezon, Philippines.

REYNI D. !D"!N#$!Y!N !%%I!N2

S$SCRI$ED !ND SG5RN to befoe (e this :8 th *'yof !pil, :8+< 't Quezon City, !Fi'nt est'blishin& to (e hisDi3eHs "icense N56-7-8879, issue* 't Quezon City on%ebu'y :8, :8+7.

N52!RY P$"IC

Doc. No. P'&e No.

$oo= No. Seies of :8+<