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Affidavit of Accident

Carlito Arginte Jr. was driving a 40 ft. container truck out of the warehouse gate at 502 J. P. Rizal St. in Malanday Marikina City on November 7, 2019 when he accidentally hit a portalette outside the gate. The accident happened quickly and was beyond his control. He has sworn this affidavit to attest to the truth of his statement and to support his insurance claim for reimbursement for the damaged portalette.

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49 views1 page

Affidavit of Accident

Carlito Arginte Jr. was driving a 40 ft. container truck out of the warehouse gate at 502 J. P. Rizal St. in Malanday Marikina City on November 7, 2019 when he accidentally hit a portalette outside the gate. The accident happened quickly and was beyond his control. He has sworn this affidavit to attest to the truth of his statement and to support his insurance claim for reimbursement for the damaged portalette.

Uploaded by

cris jaluage
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOC, PDF, TXT or read online on Scribd
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REPUBLIC OF THE PHILIPPINES)

CITY OF ______________________)

AFFIDAVIT OF ACCIDENT

I, CARLITO T. ARGINTE JR., Filipino, of legal age, with residence address at


2170 INFANTA ST., BALUT TONDO MANILA, after having been duly sworn to in
accordance with law, hereby, depose and say that:

I am the authorized driver of one motor vehicle which is particularly described as


follows:

MAKE AND MODEL :


SERIAL NUMBER :
MOTOR NUMBER :
PLATE NUMBER : CC08439

On November 7, 2019 at around 22:27 hours in the afternoon, I accidentally hit


the PORTALET outside of the warehouse gate at 502 J. P. Rizal St., Malanday Marikina
City (Merit Stinless Steel, Inc.). While I’m driving the 40 ft. Container Truck going out
from the warehouse, I did not immediately notice that I hit the PORTALET that causes of
its damage. The accident happened so fast and went beyond my control.

I am executing this affidavit to attest to the truth of the foregoing statement and in
support of my claims for reimbursement from the insurance company.

CARLITO T. ARGINTE JR.


Affiant

SUBSCRIBED AND SWORN to before me this _______day of _____________,


20___ at ________________, Affiant exhibiting to me his Driver’s License No. NN04-
17-007833 issued at _____________on _____________________.

NOTARY PUBLIC

Doc. No. _______


Page No. _______
Book No._______
Series of 2019

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