REPUBLIC OF THE PHILIPPINES) CITY OF ______________________) AFFIDAVIT OF ACCIDENT I, _____________________________, Filipino, of legal age, with residence address at ___________________________________________, after having been duly sworn to in accordance with law, hereby, depose and say that: I am the authorized driver of one motor vehicle which is particularly described as follows: MAKE AND MODEL SERIAL NUMBER MOTOR NUMBER PLATE NUMBER
On January 24, 2013 at around four o’clock in the afternoon, I was driving along Airport Road at Parañaque City going southbound. In the same lane, a ten-wheeler truck was also traversing the road on my right side on a fast speed. As the truck was very fast, I did not immediately notice that it sideswiped the right side portion of my driven vehicle. Unfortunately, I was not able to stop the driver of the truck nor get the plate number of the truck. The accident happened so fast and went beyond my control. I am executing this affidavit to attest to the truth of the foregoing statement and in support of my claims for reimbursement from the insurance company.
SUBSCRIBED AND SWORN to before me this _______day of _____________, 20___ at ________________, Affiant exhibiting to me his/her Residence Certificate No./ Valid Identification _____________________________ issued at _____________ on _____________________.
NOTARY PUBLIC Doc. No. _______ Page No. _______ Book No._______ Series of _______
