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    Affidavit of Own Damage Form

    Uploaded by

    Marichel
    The document is an affidavit from a vehicle owner in the Philippines describing damage to their vehicle from an incident. It states that on April 30th at 7pm, while driving home, a small rock hit their vehicle and damaged the front shield. The owner is filing this affidavit to support an insurance claim to repair the damage caused to their vehicle.

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

    Affidavit of Own Damage Form

    Uploaded by

    Marichel
    163 views2 pages
    The document is an affidavit from a vehicle owner in the Philippines describing damage to their vehicle from an incident. It states that on April 30th at 7pm, while driving home, a small rock hit their vehicle and damaged the front shield. The owner is filing this affidavit to support an insurance claim to repair the damage caused to their vehicle.

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    Legal Form

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    The document is an affidavit from a vehicle owner in the Philippines describing damage to their vehicle from an incident. It states that on April 30th at 7pm, while driving home, a small rock hit their vehicle and damaged the front shield. The owner is filing this affidavit to support an insurance claim to repair the damage caused to their vehicle.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    163 views2 pages

    Affidavit of Own Damage Form

    Uploaded by

    Marichel
    The document is an affidavit from a vehicle owner in the Philippines describing damage to their vehicle from an incident. It states that on April 30th at 7pm, while driving home, a small rock hit their vehicle and damaged the front shield. The owner is filing this affidavit to support an insurance claim to repair the damage caused to their vehicle.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    Republic of the Philippines)

    )S.S.
    x--------------------------------------/
    AFFIDAVIT OF OWN DAMAGE TO VEHICLE

    I, __________________, of legal age, Filipino, married and presently


    residing at _________________, Mandaue Cebu, Philippines after having
    been duly sworn to in accordance with law, depose and say that:
    1. That I am a duly licensed driver with Driver's License No.
    _________, which is valid until ____________.

    2. That on April 30, at around 7:00 in the evening, I was driving a


    vehicle owned and registered in my name which is more
    particularly described as follows:
    Make : Engine No.:
    Series: Chassis No.:
    Body Type : Plate No.:
    Year Model: MV File No.:

    3. That while I was on my way home, the aforementioned vehicle


    was suddenly hit by a small rock at SRP Road and as a result the
    said vehicle sustained damage at its front shield;

    4. That 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 my vehicle.
    IN WITNESS WHEREOF, I have hereunto set my hand this _____
    day of __________________, at __________________________,
    Philippines.

    _______________________
    Affiant
    Driver’s License No. ___________

    SUBSCRIBED AND SWORN TO before me this ____day of


    ____________, at _________________________, Philippines, affiant
    exhibiting to me his valid proof of identification as shown above.

    Doc No. _______;


    Page No. ______;
    Book No. ______;
    Series of 2022.

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