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Driver'S Affidavit

The driver, Ana Edna Reginaldo Almacen, provides an affidavit detailing two accidental incidents involving the vehicle she was driving. On July 20, 2016 she bumped a concrete barrier causing scratches to the vehicle. On August 8, 2016 she accidentally bumped a parked motorcycle causing damage to its front bumper. She confirms she held a valid driver's license at the time and provides documentation to support insurance claims from the incidents.

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25 views1 page

Driver'S Affidavit

The driver, Ana Edna Reginaldo Almacen, provides an affidavit detailing two accidental incidents involving the vehicle she was driving. On July 20, 2016 she bumped a concrete barrier causing scratches to the vehicle. On August 8, 2016 she accidentally bumped a parked motorcycle causing damage to its front bumper. She confirms she held a valid driver's license at the time and provides documentation to support insurance claims from the incidents.

Uploaded by

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

City of Davao . . . . . . . . .)s.s.


X - - - - - - - - - - - - - - - -/

DRIVERS AFFIDAVIT

I, ANA EDNA REGINALDO ALMACEN, of legal age, Filipino, married


and a resident of 2nd Blk, Fernandez Subdivision, Tacurong City, under oath
depose and say:

1. That I am the driver of that Spin Chevrolet AUV bearing Temporary


Plate No. with MV File No. 130100000512830, Chassis No.
MJBJA7580FJ1C6255, CR No. 230051754 registered in the name of
Rogelio S. Almacen;

2. That on July 20, 2016 at about 5:00 PM at our residence, I


accidentally bumped the concrete canal barrier causing scratches at
the Front Right Door and Rear Right Door of the vehicle;

3. That on or about 8:00 AM of August 8, 2016 at our residence, I


accidentally bumped the parked motorcycle causing damaged on its
front bumper;

4. That at the time the incidents happened, I am holding a valid


drivers license; That hereto attached is a copy of my drivers
license and the Certificate of Registration of the motor vehicle;

5. That I execute this affidavit purposely to attest to the truth of the


above facts and circumstances purposely in support of the
insurance claims arising out of the above mentioned incident and
for whatever legal purpose it may serve;

IN WITNESS WHEREOF, I have hereunto set my hand this September 5,


2015 at Davao City, Philippines.

ANA EDNA REGINALDO ALMACEN


Affiant

SUBSCRIBED AND SWORN to before me this September 5, 2016 at


Davao City, Philippines, personally appeared the affiant showing her Drivers
License No. M07-15-2264 as her competent proof of identity.

Doc No.___;
Page No.___;
Book No.___;
Series of 2016

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