Scribd
Upload
87 views1 page

Incident Report: Evangeline M. Gutierrez

Evangeline Gutierrez files an incident report after her driver, Arnel Constantino, accidentally rammed a huge pile of boulders while reversing her 2019 Toyota Fortuner after attending a meeting in Cabanatuan City, Nueva Ecija on January 6, 2020. This caused deep scratches and dents to the lower bumper. She writes the report to inform authorities of the accident and request an investigation for indemnification purposes.

Uploaded by

Jan Kenrick Sagum
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
87 views1 page

Incident Report: Evangeline M. Gutierrez

Evangeline Gutierrez files an incident report after her driver, Arnel Constantino, accidentally rammed a huge pile of boulders while reversing her 2019 Toyota Fortuner after attending a meeting in Cabanatuan City, Nueva Ecija on January 6, 2020. This caused deep scratches and dents to the lower bumper. She writes the report to inform authorities of the accident and request an investigation for indemnification purposes.

Uploaded by

Jan Kenrick Sagum
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

INCIDENT REPORT

I, Evangeline M. Gutierrez, of legal age, Filipino, and a resident of


Tutuban 2, Brgy. San Roque, Gapan City, Nueva Ecija, after having been
duly sworn to in accordance with law, do hereby deposes and states that
last January 6, 2020, at around 7:00 in the evening, after attending to
an important meeting at Edgardo’s Café, Vergara Bypass Rd., Brgy. Sta
Arcadia, Cabanatuan City, Nueva Ecija, the driver, Mr. Arnel
Constantino, operating the vehicle, a 2019 Toyota Fortuner with Plate
No. CAT 1201, reversely maneuvered the vehicle towards the direction
going to San Leonardo bypass road, when suddenly a huge pile boulder
was unintentionally rammed by the vehicle, upon advancing towards the
direction going to San Leonardo, which went under the vehicle which
caused deep scratches, as well as dents, in the lower portion of the
bumper of the vehicle. I am writing this Incident Report to inform the
proper authorities of the accident that took place involving my vehicle,
and further make a recommendation that an investigation regarding the
said incident be made for purposes of indemnification.

Respectfully yours,

EVANGELINE M. GUTIERREZ
Affiant

You might also like