Affidavits

REPUBLIC OF THE PHILIPPINES
[Province/City/Municipality]) S.S.

AFFIDAVIT OF ACCIDENT

I, [Full Name], of legal age, [civil status], [nationality], and presently residing at [Complete Address], after having been duly sworn to in accordance with law, depose and state:

1. That I am the owner/driver/passenger/claimant in connection with the accident involving [Vehicle/Person/Property], which occurred on [Exact Date], at around [Time], at [Exact Location of Accident];

2. That at the time of the accident, I was [briefly explain what you were doing, e.g., driving my vehicle with plate number XXX, crossing the street, working at my office, etc.], when the incident took place;

3. That the accident occurred due to [brief description of how the accident happened — e.g., the vehicle skidded due to slippery road, I was rear-ended by another car, etc.];

4. That as a result of the said accident, [briefly state the damage or injury — e.g., I sustained injuries to my right leg / my vehicle incurred damage to the rear bumper, etc.];

5. That I reported the said incident to the proper authorities and/or the insurance provider, and this affidavit is being executed in support of my insurance claim and for whatever legal purpose it may serve; and

6. That I am executing this affidavit freely, voluntarily, and truthfully to the best of my knowledge and recollection.

IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of [month], [year], at [place of execution].

[Full Name]
Affiant

SUBSCRIBED AND SWORN TO before me in the City/Municipality of [location], this ___ day of [month], [year], by affiant who has satisfactorily proven his/her identity through [Government ID type and number], issued on [date] and expiring on [date], that he/she is the same person who personally signed before me the foregoing Affidavit of Loss and acknowledged that he/she executed the same.

NOTARY PUBLIC

Doc No. ____;

Page No.____;

Book No. ___; 

Series of [YEAR].