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Affidavit Fic

The affidavit details a series of unfortunate events involving a black Toyota Hilux vehicle owned by the affiant. First, something struck and cracked the windshield while driving on South Road Properties. That evening, the vehicle was involved in a collision with a black motorcycle that was parked in a dark area. Fortunately, there were no injuries. The affiant executed this affidavit to attest to the truth of the statements and to support an insurance claim to repair the vehicle's damage.

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Jigo Dacua
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81 views1 page

Affidavit Fic

The affidavit details a series of unfortunate events involving a black Toyota Hilux vehicle owned by the affiant. First, something struck and cracked the windshield while driving on South Road Properties. That evening, the vehicle was involved in a collision with a black motorcycle that was parked in a dark area. Fortunately, there were no injuries. The affiant executed this affidavit to attest to the truth of the statements and to support an insurance claim to repair the vehicle's damage.

Uploaded by

Jigo Dacua
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)

CITY OF CEBU ) S.S.

AFFIDAVIT

I, ________________, of legal age, Filipino, married and a resident of 47 Lopez


Jaena Street, Cebu City, Philippines, after having been duly sworn in accordance with
law, hereby depose and state THAT –

1. I am a duly licensed driver with Driver’s License No. __________;

2. I am the authorized driver of a black Toyota Hilux Conquest with plate


No. _________;

3. The aforementioned vehicle is covered by ____________ Insurance Co.,


Inc. under Policy No. ____________;

4. On 9 October 2020, I was plying South Road Properties in going to Cebu


City Hall for work together with the owner of the vehicle ______________;

5. Suddenly, something struck the windshield of the vehicle which caused it


to crack. The said crack has grown significantly larger from time to time;

6. In the evening of the same day, I again figured in a collision with the rear
bar end of a black motorcycle which was parked on a dark space near the house of the
said owner of the vehicle. It was incidentally parked on a blind spot where the
illumination of the headlight reached it only just before the impact;

7. I am still fortunate enough despite the series of unfortunate events because


no life was taken or limb that was injured in the process;

8. I am executing this affidavit to attest the truth of the foregoing statements,


in support of the claim against the insurer for the repair of the damage caused to the
aforementioned vehicle and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hands this


________________ at Cebu City, Philippines.

_____________________
Affiant
LTO Driver’s License
ID No. _________________

SUBSCRIBED AND SWORN TO BEFORE ME this ________________ at


Cebu City, Philippines, by Affiant who exhibited his competent evidence of identity
indicated above.

Doc No. ______;


Page No. ______;
Book No. ______;
Series of 2020.

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