REPUBLIC OF THE PHILIPPINES)

IN THE CITY OF DAVAO . . . . .)S.S.

AFFIDAVIT OF ACCIDENT

I, _, of legal age, _, Filipino and a resident of _, Davao City, Philippines, after

having been duly sworn to in accordance with law, do hereby depose and state
that:

1. I am a duly licensed driver with Non-Professional Driver’s License No. _ valid

until _;

2. Around _, I parked the _ owned and registered in the name of my husband

_ in _, Davao City, particularly described as follows:

Make:
Plate Number:
Serial Number:
Motor Number:
Model:

3. When I returned to the aforementioned vehicle at _, I noticed a number of

damages on the vehicle, namely:

a.
b.

4. I had no personal knowledge as to the facts and consequences behind the

damage, nor was there any security personnel present to attest to the
damage;

5. I am executing this Affidavit to attest to the truth of the foregoing and in

support of the claim against the insurer for the repair of the damage
caused to the said vehicle.

IN WITNESS WHEREOF, I have hereunto set forth my hand this _ day of _ 2018
at Davao City, Philippines.

_
Affiant
_

SUBSCRIBED AND SWORN TO BEFORE ME this _ day of _ 2018 at Davao City,

Philippines.

Doc. No.
Page No.
Book No.
Series of 2018