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Affidavit Insurance Claim

The affidavit describes an incident where the affiant crashed a vehicle into a garage post while parking. According to the affidavit, the affiant slipped on the accelerator, causing the vehicle to hit the right front side of the garage post and damage it. In avoiding further crashes, the affiant braked too hard, scratching the rear passenger door on another post. The affidavit was filed to support an insurance claim for the damages caused in the single incident.

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270 views1 page

Affidavit Insurance Claim

The affidavit describes an incident where the affiant crashed a vehicle into a garage post while parking. According to the affidavit, the affiant slipped on the accelerator, causing the vehicle to hit the right front side of the garage post and damage it. In avoiding further crashes, the affiant braked too hard, scratching the rear passenger door on another post. The affidavit was filed to support an insurance claim for the damages caused in the single incident.

Uploaded by

neil_nail
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)

Province Of Bohol )S.S.


City of Tagbilaran )

AFFIDAVIT OF DAMAGE TO VEHICLE

I, ___________, of legal age, single, Filipino and a


resident of __________________, Bohol, after having sworn to
in accordance with law depose and state:

1. That I am a duly licensed Non-Professional Driver


with License No. _____________ valid until ______________;

2. That on December 5, 2019 at around 5:30 o’clock in


the afternoon while I am driving a vehicle owned by
______________ which is more particularly described as
follows:

MV File No. : ____________


Plate No. : ____________
Engine No. : ____________
Chassis No. : ____________
Make : ____________

3. That while I was driving the same for parking at our


house garage when I slipped and slammed the accelerator
pedal, the aforementioned vehicle hit the post causing
damage to the right front side portion (a picture of the
damage is hereto attach);

4. That I was so cautious in my next acceleration that


the rear front passenger door was also scratched on the
other post of the garage (picture also attached);

5. That the damages on the vehicle was made on the same


incident on the same day;

6. That I am executing this affidavit to attest to the


foregoing truth and in support of the insurance claim.

______________
Affiant
License No. __________

In conformity with registered owner:

_____________________
Senior Citizen No. __________

SUBSCRIBED AND SWORN to before me this ______ day of


_________ at the ________________, Bohol, Philippines.

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