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    Republic of The Philippines) CITY OF - ) SS

    Uploaded by

    LeaneSacares
    This affidavit describes a vehicle accident where the driver scratched the back left side of their vehicle while parking in their garage. It provides details of the vehicle and states the driver is filing an affidavit to claim own damage from their insurance company due to the paint being chipped on the back left side near the gas tank opening. The driver affirms the statements in the affidavit are true for the purpose of an insurance claim.

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    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd

    Republic of The Philippines) CITY OF - ) SS

    Uploaded by

    LeaneSacares
    107 views2 pages
    This affidavit describes a vehicle accident where the driver scratched the back left side of their vehicle while parking in their garage. It provides details of the vehicle and states the driver is filing an affidavit to claim own damage from their insurance company due to the paint being chipped on the back left side near the gas tank opening. The driver affirms the statements in the affidavit are true for the purpose of an insurance claim.

    Original Description:

    affidavit

    Original Title

    Affidavit of Accident

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    This affidavit describes a vehicle accident where the driver scratched the back left side of their vehicle while parking in their garage. It provides details of the vehicle and states the driver is filing an affidavit to claim own damage from their insurance company due to the paint being chipped on the back left side near the gas tank opening. The driver affirms the statements in the affidavit are true for the purpose of an insurance claim.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    107 views2 pages

    Republic of The Philippines) CITY OF - ) SS

    Uploaded by

    LeaneSacares
    This affidavit describes a vehicle accident where the driver scratched the back left side of their vehicle while parking in their garage. It provides details of the vehicle and states the driver is filing an affidavit to claim own damage from their insurance company due to the paint being chipped on the back left side near the gas tank opening. The driver affirms the statements in the affidavit are true for the purpose of an insurance claim.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
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    REPUBLIC OF THE PHILIPPINES)

    CITY OF _______________________)SS

    AFFIDAVIT OF ACCIDENT

    I, XXX, of legal age, Filipino, single, and a resident Lapu-Lapu City, after having been
    duly sworn to in accordance with law, do hereby depose and state THAT:

    1. I am the Authorized driver of a motor vehicle particularly described as follows:

    DESCRIPTION: xx
    COLOR: xx
    PLATE NO.: xx
    ENGINE NO.: xx
    CHASSIS NO.: xx

    2. While I was about to park the motor vehicle inside the garage of our house, I bumped the
    back left side of the vehicle against the gate. Due to such accident, the back left side of
    the motor vehicle (near the opening of the gas tank) scratched causing the paint of the
    vehicle to chip off.
    3. I understand that it is an incident where OWN DAMAGE to my insurance can be
    claimed, thus, this affidavit.
    4. I am executing this affidavit to attest to the truth of the foregonig statements and as a
    requirement for an OWN DAMAGE CLAIM against my insurance company, and for all
    legal intents and purposes it may serve.

    AFFIANT FURTHER SAYETH NAUGHT.

    IN WITNESS WHEREOF, I have hereunto affixed my signature this _____ day of


    _________ 2017 at the City of ____________, Philippines.
    xx
    Affiant
    Drivers License No. xx
    Issued on August 7, 2017/ Cebu City

    SUBSCRIBED AND SWORN to before me on the date and place indicated above. Affiant
    exhibited before me her Driver's License stated above.

    Doc. No. ____;


    Page No. ____;
    Book No. ____;
    Series of 2017.

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