Republic of the Philippines

NATIONAL POLICE COMMISSION

PHILIPPINE NATIONAL POLICE
CALBAYOG CITY POLICE STATION
TRAFFIC SECTION
Calbayog City

CCPSTS-

POLICE REPORT/ BLOTTER ENTRY

THIS IS TO CERTIFY that on entry No. 892 dated June 27, 2013, at around 09:50 in the
morning at the police blotter appears the following entry to wit:

RECORD PURPOSE NO. 892

That on or about 9:30 in the morning of June 26, 2013, a vehicular accident was
transpired at P-13, Brgy. San Policarpo,Calbayog City particularly in front of Boning
Diomangay Welding Shop, wherein One motorcycle Single, Honda TMX-155, color red with
plate number 4226 HM, chassis no. KB501-003-176952, engine no. KB501003-175952E,
certificate of registration 13517671-6, motor no.115354676, driven by One Eric Semillano Y
Cailo, 22 years old, married, holding a Drivers License with no. H08-10-000485 and a
resident of P-1, Brgy. Lonoy, Calbayog City, enroute from south to north direction and upon
reaching at the said place, he lost control of his driven vehicle and accidentally hit and
bumped the Two crossing pedestrians towards east direction and causing him to thrown
away from his driven vehicle.

As a consequence thereof, victims were brought to St. Camillus Hospital for proper
medical treatment and they were identified as One Dionesio Risabal, 40 years old, single
who suffered multiple injuries and One Jose Risabal Y Cinco, 9 years old, minor who also
incurred left leg fractured determined by the attending physician who were both a residents
of P-13, Brgy. San Policarpo, this city. But victims were referred to Tacloban City for better
medical treatment.

Furthermore, said single motorcycle incurred damages that need repair/replacement.

Recorded by:

(SGD) Ben Mananguite Lao

Police Officer I
Traffic Investigator

THIS IS ISSUED upon request of the interested party for whatever legal purpose it may serve
him/her best. Issued this 27th day of May 2013 at Calbayog City Philippines.

FOR THE CHIEF OF POLICE

SATURNINO TORCULAS GETIGAN

Police Inspector
Chief, Traffic/Patrol Section
Paid Under OR No. 0394029
Dated: June 27, 2013
Issued at: Calbayog City