REPUBLIC OF THE PHILIPPINES)
CITY OF PASAY)
AFFIDAVIT OF ACCIDENT
I, Joseph Ishmael P. Ferrer, Filipino, of legal age, with residence address at P33-11 9th
Street, Villamor Air Base, Pasay City, after having been duly sworn to in accordance with law, hereby depose
and say that:
I am the authorized driver of one vehicle which is particularly described as follows:
MAKE AND MODEL :
SERIAL NUMBER :
PLATE NUMBER :
On September 28, 2019 at around seven o’clock in the morning, I was making my way out
of the garage. I did not immediately notice that it sideswiped the left-side portion of my driven vehicle to the
gate. The accident happened so fast and went beyond my control.
I am executing this affidavit to attest the truth of the foregoing statement and in support of
my claims of reimbursement from the insurance company.
Joseph Ishmael P. Ferrer
Affiant