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    Affidavit of Accident

    Uploaded by

    Jason Ampong
    The affidavit describes a vehicle accident that occurred on November 8, 2018 in Cagayan de Oro City, Philippines. The affiant was parking a 2018 Mitsubishi Mirage that he was driving when he noticed the rear windshield was shattered with a stone inside upon his return. The affidavit is being submitted to support an insurance claim to repair the damage caused to the vehicle from this incident.

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    © All Rights Reserved
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    Affidavit of Accident

    Uploaded by

    Jason Ampong
    72 views1 page
    The affidavit describes a vehicle accident that occurred on November 8, 2018 in Cagayan de Oro City, Philippines. The affiant was parking a 2018 Mitsubishi Mirage that he was driving when he noticed the rear windshield was shattered with a stone inside upon his return. The affidavit is being submitted to support an insurance claim to repair the damage caused to the vehicle from this incident.

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    sample affidavit

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    The affidavit describes a vehicle accident that occurred on November 8, 2018 in Cagayan de Oro City, Philippines. The affiant was parking a 2018 Mitsubishi Mirage that he was driving when he noticed the rear windshield was shattered with a stone inside upon his return. The affidavit is being submitted to support an insurance claim to repair the damage caused to the vehicle from this incident.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    72 views1 page

    Affidavit of Accident

    Uploaded by

    Jason Ampong
    The affidavit describes a vehicle accident that occurred on November 8, 2018 in Cagayan de Oro City, Philippines. The affiant was parking a 2018 Mitsubishi Mirage that he was driving when he noticed the rear windshield was shattered with a stone inside upon his return. The affidavit is being submitted to support an insurance claim to repair the damage caused to the vehicle from this incident.

    Copyright:

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

    REPUBLIC OF THE PHILIPPINES ]

    CITY OF CAGAYAN DE ORO ] S.S.

    AFFIDAVIT OF ACCIDENT

    I, __________________, of legal age, Filipino, single and a resident of


    ____________________, Cagayan de Oro City, Philippines, after having been duly
    sworn to an oath in accordance with law, hereby depose and say, that:

    I am a duly licensed driver issued with Professional Driver’s License No.


    ______________ by the Land Transportation Office;

    On November 8, 2018, I was driving a Mitsubishi Mirage, covered with Certificate


    of Registration No. _________ and Official Receipt No. _____________, both issued by
    the Land Transportation Office, owned and registered under the name of my uncle
    ____________ and is more particularly described as follows:

    Engine No.: Chassis No.:


    Conduction no.: Fuel: Gasoline Make:
    Mitsubishi Series:
    Body Type: Hatchback Year:

    On November 8, 2018 at around 10:30 in the morning, I parked the said vehicle
    adjacent to cdod while I was purchasing some items. When I went back on the said
    area where I parked the vehicle, I noticed that its rear windshield has been shattered. I
    also noticed a piece of stone inside the compartment which seemed to be the cause of
    the incident;

    Due to the said incident, I am now constrained to have the said vehicle undergo
    some repairs to avoid further damage;

    I am executing this affidavit to attest to the truth of the foregoing and in support of
    the claim against the insurer for the repair of the damage caused to the said vehicle.

    IN WITNESS WHEREOF, I have hereunto set my hand this November 8, 2018 at


    Cagayan de Oro City, Philippines.

    __________________
    Affiant

    SUBSCRIBED AND SWORN TO before me this November 8, 2018 at Cagayan


    de Oro City, Philippines.

    Doc. No.:
    Page No.:
    Book No.:
    Series of 2018.

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