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Affidavit of Vehicular Accident

This affidavit describes a vehicular accident involving the affiant. It states that the affiant owns a vehicle that was involved in an accident on a specific date and location. The affiant's vehicle and another vehicle, driven by an unnamed person, were hurrying and did not stop to call the police to record the accident details. The affiant is signing this affidavit to attest to the truth of the accident circumstances and to report the matter to their insurance company for a claim.

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244 views1 page

Affidavit of Vehicular Accident

This affidavit describes a vehicular accident involving the affiant. It states that the affiant owns a vehicle that was involved in an accident on a specific date and location. The affiant's vehicle and another vehicle, driven by an unnamed person, were hurrying and did not stop to call the police to record the accident details. The affiant is signing this affidavit to attest to the truth of the accident circumstances and to report the matter to their insurance company for a claim.

Uploaded by

gbv
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)

)S.S.

AFFIDAVIT OF VEHICULAR ACCIDENT

I, _______________ of legal age, married/single, Filipino, and residing at


_____________, after having been duly sworn to according to law, hereby depose and
state:

1. That I am the registered owner of a motor vehicle which is specifically


described as follows:

_____________________
MODEL :
MOTOR NO. :
CHASSIS NO. :
COLOR :
PLATE NO. :
2. That said motor vehicle figured in an accident on ______, at about
______am/pm while I was driving it along _______ and as I was trying to
________, an ___________ with Plate No.__ driven by certain ______ tried to
__________;

3. As we were both in hurry and __________, we did not bother anymore to


summon a policeman to record the accident;

4. That I am executing this affidavit in order to attest to the truth of the


foregoing circumstances and for the purpose of reporting the matter to my
insurance office for insurance claims.

IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of


___________ , at the City of __________-.

AFFIANT

SUBSCRIBED AND SWORN to before me, this ________ by _____ who exhibited
to me his/her ID No. Issued at __________, Philippines on ______.

Doc No.:__
Page No.:__
Book No.:___
Series of 202__

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