Republic of the Philippines)

City of __________ ) S.S 

AFFIDAVIT OF CAR ACCIDENT

I, ________, of legal age, ______, ______ and a resident of ________________having

duly sworn in accordance with law, do hereby depose and state that:

1. That I am the driver and registered owner of the following described-vehicle:

Brand:
Model:
Plate #:
 
2. That on ________ at around 8:15 in the evening, I accidentally hit the electrical
post outside our house due to poor lighting in area. I wasn’t able to see the
electrical post and hit my car with it. As a result, my bumper and tail light got
deformed, cracked and damaged.
 
3. I am executing this affidavit to attest to the truth of the foregoing and for whatever
legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto affixed our hands this _______________

at Quezon City, Philippines.

_____________________________
  Affiant

SUBSCRIBE AND SWORN  TO before me this __________________________,

affiant exhibiting to me his driver’s license ID no. _________________.

Doc. No.___
Page No.___
Book No.___
Series of 2023