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Affidavit of Accident Template

This affidavit describes a car accident that occurred on January 4, 2022. The affiant owns a Toyota Vios that was parked outside the home of Ms. [name redacted] when it was unintentionally struck by a passing Toyota Innova. The affiant is filing this affidavit to attest to the truth of the accident details and to report the incident to their insurance company to file an insurance claim.

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Alyssa Fabella Reyes
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169 views1 page

Affidavit of Accident Template

This affidavit describes a car accident that occurred on January 4, 2022. The affiant owns a Toyota Vios that was parked outside the home of Ms. [name redacted] when it was unintentionally struck by a passing Toyota Innova. The affiant is filing this affidavit to attest to the truth of the accident details and to report the incident to their insurance company to file an insurance claim.

Uploaded by

Alyssa Fabella Reyes
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 )

City of Caloocan ) S.S.

AFFIDAVIT of ACCIDENT

I, ___________, Filipino, of legal age, single/married, with address at


____________________________, Philippines, after having been sworn in accordance
with law, hereby depose and state that:

1. I am the registered owner of a Toyota Vios with plate number ______;

2. I authorized Ms. ______ to use the vehicle since 20__;

3. At around 1 pm of January 04, 2022, while my vehicle was parked in front of Ms.
______'s home at __________________________, a Toyota Innova with the
plate number _________ drove past my vehicle.

4. The Toyota Innova unintentionally struck the left side portion of my car which
cause noticeable scratches and damage;

5. I am executing this affidavit for purposes of attesting to the truth of the


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

________________, __________, 20____.

____________________
Affiant

SUBSCRIBED AND SWORN to before me this __________________________ at


_________________________ affiant presenting to me his competent evidence
of identity by way of the following:

NAME ID with Number issued on and valid until

Doc. No.: ___________


Page No.:___________
Book No.:___________
Series of 2023.

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