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    Affidavit of Damage Claim From Insurance

    Uploaded by

    Huey Calabines
    Noli Anne L. Notorio files an affidavit of insurance claim after backing her car, a 2019 Toyota Vios, into the closed garage gate on December 28, 2020. In her affidavit, she details that she has a valid driver's license and was moving the car, registered under Gilbert M. Galla, from the garage when she mistakenly believed her husband had opened the gate fully. This caused damage to the rear bumper and an insurance claim was filed by the owner. Notorio signs the affidavit to recover insurance proceeds for the accident.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Affidavit of Damage Claim From Insurance

    Uploaded by

    Huey Calabines
    566 views1 page
    Noli Anne L. Notorio files an affidavit of insurance claim after backing her car, a 2019 Toyota Vios, into the closed garage gate on December 28, 2020. In her affidavit, she details that she has a valid driver's license and was moving the car, registered under Gilbert M. Galla, from the garage when she mistakenly believed her husband had opened the gate fully. This caused damage to the rear bumper and an insurance claim was filed by the owner. Notorio signs the affidavit to recover insurance proceeds for the accident.

    Original Description:

    Affidavit of Damage Claim from Insurance

    Original Title

    Affidavit of Damage Claim from Insurance

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    Noli Anne L. Notorio files an affidavit of insurance claim after backing her car, a 2019 Toyota Vios, into the closed garage gate on December 28, 2020. In her affidavit, she details that she has a valid driver's license and was moving the car, registered under Gilbert M. Galla, from the garage when she mistakenly believed her husband had opened the gate fully. This caused damage to the rear bumper and an insurance claim was filed by the owner. Notorio signs the affidavit to recover insurance proceeds for the accident.

    Copyright:

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

    Affidavit of Damage Claim From Insurance

    Uploaded by

    Huey Calabines
    Noli Anne L. Notorio files an affidavit of insurance claim after backing her car, a 2019 Toyota Vios, into the closed garage gate on December 28, 2020. In her affidavit, she details that she has a valid driver's license and was moving the car, registered under Gilbert M. Galla, from the garage when she mistakenly believed her husband had opened the gate fully. This caused damage to the rear bumper and an insurance claim was filed by the owner. Notorio signs the affidavit to recover insurance proceeds for the accident.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    REPUBLIC OF THE PHILIPPINES

    CITY OF BACOOR

    AFFIDAVIT OF INSURANCE CLAIM

    I, NOLI ANNE L. NOTORIO, of legal age, Filipino, married and a


    resident of Phase 7-B Blk 29 Lot 7 Elliston Place Pasong Camachile General Trias,
    Cavite, Philippines, after having been sworn to in accordance with law do hereby
    depose and state that:

    1. I am a duly licensed driver with a valid non-professional driver’s license


    with license no. N26-13-002227 which is valid until 2023/05/03;

    2. On December 28, 2020, at around 9:00 a.m., I drove a motor vehicle


    registered under the name of Gilbert M. Galla, which motor vehicle is more
    particularly described as follows:

    Make/Year: TOYOTA/2019
    Series: VIOS 1.3 E
    Body Type: SEDAN
    MV File: 1380-00001116377
    Engine No.: INRX422548
    Case No.: 346529234
    Plate No.: NEC9094

    3. On the said date and time, I was about to move out the car from our
    garage when I thought my husband already open the gate. Suddenly, I heard the car
    bumped into the gate and found out that our gate was not widely opened.

    4. Due to this happening, the car obtained damage on its rear bumper
    causing the owner to file an insurance claim from its insurance company.

    5. I attest to the truthfulness of the above facts and I am executing this


    Affidavit to recover insurance proceeds and for other purposes as it may serve.

    IN WITNESS WHEREOF, I have hereunto affixed my signature this 24 th


    day of February 2021 in the City of Bacoor, Cavite.

    NOLI ANNE L. NOTORIO

    SUBSCRIBED AND SWORN to before me this _____________ in the City


    of ___________, affiant exhibiting to me her valid license id.

    Doc No.
    Page No.
    Book No.
    Series of 2021.

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