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Affidavit for Vehicle Damage Claim

Bienvenido B. De Leon files an affidavit stating that on March 25, 2018 while driving his family from Tarlac City to Pasay City, he accidentally hit the back of a Montero which then bumped into a Mitsubishi Adventure causing unknown damages. De Leon was driving a Hyundai Accent registered under his wife's name, Kathleen Ragunot De Leon, and is executing this affidavit to support an insurance claim for the damage caused in the accident.

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Michael Angelo Lumboy
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204 views1 page

Affidavit for Vehicle Damage Claim

Bienvenido B. De Leon files an affidavit stating that on March 25, 2018 while driving his family from Tarlac City to Pasay City, he accidentally hit the back of a Montero which then bumped into a Mitsubishi Adventure causing unknown damages. De Leon was driving a Hyundai Accent registered under his wife's name, Kathleen Ragunot De Leon, and is executing this affidavit to support an insurance claim for the damage caused in the accident.

Uploaded by

Michael Angelo Lumboy
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd

AFFIDAVIT OF DAMAGE TO VEHICLE

KNOW ALL MEN BY THESE PRESENTS:


I, BIENVENIDO B. DE LEON, of legal age, Filipino, married, and a resident of B20,
L61, Fiesta Communities, Matatalaib, Tarlac City, after having duly sworn to in
accordance with law, depose and state:
1. That I am a duly licensed driver with Driver’s License No. C11-10-010518
which is valid until 07-10-2018;
2. That on March 25, 2018, I am driving a Hyundai Accent with Plate No.
MT8161, we are travelling from Fiesta Communities Matatalaib, Tarlac City
going to Nichols Villamor Airbase, Pasay City around 9:00 PM with my
family to stay on our rented dormitory for the preparation of the enrolment
of my son, Clifford De Leon for the next semester in Philippine State College
of Aeronautics.
3. While travelling southbound the North Luzon Expressway (NLEX) around
10:00 to 10:30 PM, the I was driving accidentally hit and bumped the back
door of the MONTERO which in turn caused it to bumped onto a Mitsubishi
Adventure as domino effect resulting in damages of undetermined amount;
4. That said vehicle is owned and registered in the name of KATHLEEN
RAGUNOT DE LEON and is more particularly described as follows:

Model: Hyundai Accent


Color: Silver
Plate No.: MT8161
5. That I am executing this affidavit to attest to the truth the foregoing
statements and in support of the claim with the insurer for the damage
caused.
IN WITNESS WHEREOF, I have hereunto set my hands this
__________________ at Tarlac City, Philippines.

BIENVENIDO B. DE LEON
Affiant

SUBSCRIBED AND SWORN to before me this _________________ at Tarlac


City, Philippines.

Doc. No. _______;


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

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