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    Affidavit of Damage

    Uploaded by

    Bong Roque
    The affidavit describes damage to a Toyota Avanza vehicle. The owner states that on October 9, 2017 while entering a premises, they did not notice a small tree on the pavement and ran over it. This caused the tree to hit and damage the vehicle's right side headlights and bumper. The affidavit is being executed to substantiate an insurance claim for the damage with People's General Insurance Corporation.

    Copyright:

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

    Affidavit of Damage

    Uploaded by

    Bong Roque
    190 views1 page
    The affidavit describes damage to a Toyota Avanza vehicle. The owner states that on October 9, 2017 while entering a premises, they did not notice a small tree on the pavement and ran over it. This caused the tree to hit and damage the vehicle's right side headlights and bumper. The affidavit is being executed to substantiate an insurance claim for the damage with People's General Insurance Corporation.

    Original Title

    AFFIDAVIT OF DAMAGE

    Copyright

    © © All Rights Reserved

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    The affidavit describes damage to a Toyota Avanza vehicle. The owner states that on October 9, 2017 while entering a premises, they did not notice a small tree on the pavement and ran over it. This caused the tree to hit and damage the vehicle's right side headlights and bumper. The affidavit is being executed to substantiate an insurance claim for the damage with People's General Insurance Corporation.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    190 views1 page

    Affidavit of Damage

    Uploaded by

    Bong Roque
    The affidavit describes damage to a Toyota Avanza vehicle. The owner states that on October 9, 2017 while entering a premises, they did not notice a small tree on the pavement and ran over it. This caused the tree to hit and damage the vehicle's right side headlights and bumper. The affidavit is being executed to substantiate an insurance claim for the damage with People's General Insurance Corporation.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    AFFIDAVIT OF DAMAGE

    I, ________________, of legal age, Filipino and with postal address at


    ____________________, after being duly sworn in accordance with law, do hereby
    depose and state:

    1. I am the registered owner of a motor vehicle, more particularly described as


    follows:
    Make: Toyota Avanza 1.3E AT
    Color: Champagne Metallic
    Model: ________
    Plate No.: ___________
    CR No.: __________

    2. Last October 9, 2017 at around 7:00pm, as I entered the premises of


    ________________, I did not notice that a small tree was on the pavement. When I ran
    over the tree, I heard a loud thud underneath the vehicle. In my panic, I stepped on the
    gas pedal instead of the brakes.

    3. As a consequence, the tree hit and damaged the vehicle’s right side
    headlights, as well as the bumper.

    4. I am executing this affidavit to attest to the truth of the foregoing and for the
    purpose of substantiating the claim for damage with People’s General Insurance
    Corporation.

    IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of


    __________, 20___ in _________________.

    Affiant

    Republic of the Philippines }


    City of San Fernando, Pampanga } S.S.
    x--------------------------------------------x

    SUBSCRIBED AND SWORN TO BEFORE ME this _____ day of ________,


    20___, affiant exhibiting to me his Driver’s License No. _____________________
    expiring on ________________.

    WITNESS MY HAND AND NOTARIAL SEAL on the date and at the place first
    above-written.

    Notary Public

    Doc. No. ____


    Page No. ____
    Book No. ____
    Series of 20___.

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