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    Affidavit of Insurance - Alfonzo Tan

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    czabina fatima delica
    Alfonso Co Tan owns a 2013 Mitsubishi Mirage with plate number EBY 648. On September 6, 2018, while the car was parked in Naga City, it was hit by a tricycle according to witnesses, causing damage to the driver's side. Alfonso is submitting this affidavit to attest to the details of the incident and for the purposes of an insurance claim. He signed the affidavit on September 17, 2018 in Legazpi City.

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    Affidavit of Insurance - Alfonzo Tan

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    czabina fatima delica
    4K views1 page
    Alfonso Co Tan owns a 2013 Mitsubishi Mirage with plate number EBY 648. On September 6, 2018, while the car was parked in Naga City, it was hit by a tricycle according to witnesses, causing damage to the driver's side. Alfonso is submitting this affidavit to attest to the details of the incident and for the purposes of an insurance claim. He signed the affidavit on September 17, 2018 in Legazpi City.

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    Affidavit for Insurance Claim

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    Alfonso Co Tan owns a 2013 Mitsubishi Mirage with plate number EBY 648. On September 6, 2018, while the car was parked in Naga City, it was hit by a tricycle according to witnesses, causing damage to the driver's side. Alfonso is submitting this affidavit to attest to the details of the incident and for the purposes of an insurance claim. He signed the affidavit on September 17, 2018 in Legazpi City.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    4K views1 page

    Affidavit of Insurance - Alfonzo Tan

    Uploaded by

    czabina fatima delica
    Alfonso Co Tan owns a 2013 Mitsubishi Mirage with plate number EBY 648. On September 6, 2018, while the car was parked in Naga City, it was hit by a tricycle according to witnesses, causing damage to the driver's side. Alfonso is submitting this affidavit to attest to the details of the incident and for the purposes of an insurance claim. He signed the affidavit on September 17, 2018 in Legazpi City.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    Republic of the Philippines]

    City of Legazpi ] s.s.


    x--------------------------------------------x

    AFFIDAVIT OF INSURANCE
    I, ALFONSO CO TAN, of legal age, Filipino citizen and with address at Felipe II Street,
    Daet, Camarines Norte, after having been duly sworn to in accordance with law, do hereby
    depose and states that:
    1. I am the duly registered owner of Mitsubishi Mirage with plate number EBY 648
    and more particularly described as follows:

    Make: Mitsubishi Year Model: 2013


    Engine No.: 3A92UAL2805 Frame No.: MMBXNA03ADH010238
    Model No.: Mirage GLX 1.26 Plate No.: EBY 648
    2. That on September 6, 2018 around 9:00 o’clock in the evening, while my
    Mitsubishi Mirage was parked at Mayon Avenue, Naga City, it was hit by a tricycle
    vehicle according to some witnesses, which caused deformity on the driver’s side
    of the said car.
    3. I am executing this Affidavit to attest to the truth of the foregoing statement and
    in purposes of insurance claim.

    IN WITNESS WHEREOF, I have hereunto set my hand this 17th day of September 2018
    at Legazpi City, Philippines.

    ALFONSO CO TAN
    Affiant
    ID No. _________________
    Issued by ______________

    SUBSCRIBED AND SWORN to before me this 17th day of September 2018 at Legazpi
    City, Philippines, affiant exhibited himself to me his identification card indicated below his
    name bearing his photograph and genuine signature as competent proof of his identity
    pursuant to the 2004 Rules on Notarial Practice.

    Doc. No. ____;


    Page No. ____;
    Book No. ____;
    Series of 2018.

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