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Affidavit of Damage Tawi

William Uy files an affidavit to report damage to his 2007 Hyundai vehicle from a flying stone. On November 20, 2018 while driving on the National Highway in Davao City, a large stone emanating from the roadside hit and cracked the front windshield of his vehicle. He was unable to avoid the stone but executes the affidavit to inform authorities of the incident and damage for any legal purposes.

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Elan Mae Bastasa Sarsona
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381 views2 pages

Affidavit of Damage Tawi

William Uy files an affidavit to report damage to his 2007 Hyundai vehicle from a flying stone. On November 20, 2018 while driving on the National Highway in Davao City, a large stone emanating from the roadside hit and cracked the front windshield of his vehicle. He was unable to avoid the stone but executes the affidavit to inform authorities of the incident and damage for any legal purposes.

Uploaded by

Elan Mae Bastasa Sarsona
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Republic of the Philippines )

City of Davao )S.S.


x------------------------------------/

AFFIDAVIT OF DAMAGE
I, William G. Uy, of legal age, married, Filipino, and a resident of 33 OPAL
ST., ECOLAND, Davao City, Philippines, after having been duly sworn in
accordance with law, hereby depose and say that:

1. I am the registered owner of a motor vehicle described as follows:

MAKE : HYUNDAI
BODY TYPE : PRIME MOVER
YEAR MODEL : 2007
MV FILE NO. : 1210-00000152716`
CHASSIS NO. : MMBJNKA40DD029164
ENGINE NO. : 4D56UCED8847

2. Last November 20, 2018 at around 2:00 o’clock in the afternoon, when I was
driving the said vehicle from National Highway, Los Amigos, Tugbok, Davao City, a
large flying stone emanating from the roadside accidentally hit the vehicle’s front
portion of the windshield, resulting to a crack thereof.

3. It was unfortunate, but the flying stone could not have been reasonably avoided
despite my diligent effort to do so. I actually had no means to ascertain how come the
stone came flying towards to the windshield resulting to such damage.

4. I am voluntarily executing this affidavit to attest to the truth of the foregoing facts,
to apprise the concerned authorities and entities of the matter and for whatever legal
purpose the same may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this


__________________
at Davao City, Philippines.

GLEN BERNARD A. ESCOLAR


Affiant

SUBSCRIBED AND SWORN TO before me this ____________________ at


Davao City, Philippines, affiant having exhibited to me his sufficient evidence of
identity with__________________________.

Doc. No.: ____


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

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