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Affidavit for Vehicle Damage Claim

Cesar F. Ubando Jr. filed an affidavit of damage to vehicle to attest to damaging the front right fender of a Toyota Vios he was driving along Malanday Marikina City. In the affidavit, he details that on September 15, 2019 at 6:30 pm, he did not notice a pothole in the ground, which resulted in damage to the front right fender of the vehicle registered under Wilma U. Payod. Ubando executed the affidavit to support an insurance claim for the repair of the damage caused to the described motor vehicle.

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262 views2 pages

Affidavit for Vehicle Damage Claim

Cesar F. Ubando Jr. filed an affidavit of damage to vehicle to attest to damaging the front right fender of a Toyota Vios he was driving along Malanday Marikina City. In the affidavit, he details that on September 15, 2019 at 6:30 pm, he did not notice a pothole in the ground, which resulted in damage to the front right fender of the vehicle registered under Wilma U. Payod. Ubando executed the affidavit to support an insurance claim for the repair of the damage caused to the described motor vehicle.

Uploaded by

cris jaluage
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

Republic of the Philippines )

) S.S

AFFIDAVIT OF DAMAGE TO VEHICLE

I, CESAR F. UBANDO JR. ,of legal age, single, Filipino and a resident of 26 ST. LAWRENCE ST.
PUROK 3 MALANDAY MARIKINA CITY, after having been duly sworn to in accordance with law do
hereby depose and say: 1.

1. That I am a duly licensed driver with Professional Driver's License No. D16-97-159756 which
is valid until 2022-01-13;

2. That on 15 September 2019, at around 6:30 pm, I drove a motor vehicle owned and registered in
the name of WILMA U. PAYOD which is more particularly described as follows: Make:Toyota
Engine No.: 1NRX136564 Series: Vios 1.3 E GAS A Chassis No.: PA1B19F34H4026475 Body
Type: SEDAN MV File No.: 1380-00000867140 Plate No.: NBX-5597

3. That when I was driving along Malanday Marikina City I didn’t notice that there is a pothole in
the ground which resulted to the damage of its front right fender.

4. That I am executing this Affidavit to attest to the truth of the foregoing and in support of the
claim against the insurer for the repair of the damage caused to the above-described motor
vehicle.

AFFIANT SAYETH FURTHER NONE.

IN WITNESS WHEREOF, I hereunto set my hand and seal this ________________,


at_______________, Philippines.

CESAR F. UBANDO JR.


Affiant
Driver's License No. D16-97-159756

SUBSCRIBED AND SWORN to before me this ____________________, affiant personally appeared


exhibiting to me his Competent Evidence of Identity above stated.

Doc. No.
Page No.
Book No.
Series of 2019
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